The Centers for Medicare and Medicaid Services (CMS) promulgated regulations in 2018 that require hospitals to post price lists or “chargemasters” for treatments and services provided to patients. This action was taken to promote transparency for those seeking inpatient or outpatient care from hospitals. With suitable software and management system, hospitals can see a decrease in rejected claims and an increase in reimbursements.
Program and Administer
Creating a suitable CDM and staying on top of frequent regulatory changes is a daunting task for hospitals. Personnel are already busy, and resources are limited, making oversight of CDM overwhelming, and this can result in decreased reimbursements. One way to avoid overburdening hospital staff is to invest in quality software technology and CDM charge master management. It can also aid in responsiveness, compliance, and efficiency.
Feedback and Communication
Even with excellent software and management, the ability to provide feedback and communication with all departments within the hospital system is crucial for meeting goals. Defining specific roles and responsibilities regarding CDM, communicating them clearly, and making sure they are enforced can result in positive feedback and increased response time.
Update and Conform
Revise pricing documents to reflect current charges and annual pricing changes, including information about the date the document was edited, can help keep the system updated. Adding new services and products immediately is also vital to be up to date. Staying on top of these changes and additions is essential to be in compliance and to generating reimbursements.
Standardize & Synchronize
Some hospital systems have multiple sites that can complicate the maintenance of pricing systems. In these situations, an indicator of prices for the entire system and those that apply to an individual hospital that is part of the system can aid in customized prices. Large hospital systems may benefit from a parent/child relationship with each hospital in terms of CDM, which can aid in standardizing the system so that every hospital charges the same amount for services and treatment. Synchronizing supplemental CDM systems such as the pharmacy description master (PDM) with the billing system can aid in the timely submission of claims by allowing for the identification out of sync records.
Complying with the 2018 regulations to publish price lists for patients seeking care from hospitals is a challenge that can be overcome. Through appropriate software and management, administration, communication, updates, standardization, and synchronization of the CDM system, hospitals can see an increase in reimbursements.