The Chargemaster Essentials Toolkit, Second Edition

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The Chargemaster Essentials Toolkit, Second Edition

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The Chargemaster Essentials Toolkit, Second Edition

No matter the size or scope of a healthcare facility, the effort involved in maintaining a chargemaster is immense. Chargemaster coordinators, analysts, and other revenue integrity professionals must stay on top of billing and coding trends and changes, cost reporting, and charge capture.  While the list of responsibilities for revenue integrity professionals grows every day, the work they perform has a significant impact on a facility’s reimbursement and overall revenue. Thus, the increasing state and federal focus on price transparency means it is more important than ever to have an accurate, updated, and compliant chargemaster.

In its second edition, The Chargemaster Essentials Toolkit returns to provide readers with the tools needed to optimize their chargemaster and ensure accurate reimbursement and revenue integrity across their organization. This edition contains a new section on price transparency as well as updated information on certain field locations, supply charge considerations, changes to the 340B drug pricing program, and functional reporting requirements for physical and occupational therapy. It also includes updated regulatory information throughout all chapters to provide the latest information on topics relevant to chargemaster operations and management.

This book will help readers:

  • Stay on top of ongoing chargemaster education and maintenance
  • Learn best practices, strategies, and principles for chargemaster management
  • Grasp the in-depth details of Medicare’s new price transparency requirements
  • Explore the complicated world of supply charges, pharmacy charges, and bundling options
  • Master revenue cycle concepts and terminology crucial to effective chargemaster maintenance

Published: September 2019

Page count: 210
Dimensions: 8” X 11” perfect bound
ISBN: 978-1-68308-998-8

Table of Contents

Chapter 1: The Chargemaster Coordinator’s Role Within the Revenue Cycle

  • Chargemaster in the context of revenue integrity
  • Key functions of the revenue cycle
  • Vital resources for chargemaster management

Chapter 2: Chargemaster Structure and Principles

  • Chargemaster fields
  • Dynamic versus static chargemasters
  • Exploding charges
  • Relationship of chargemaster to HIM coding
  • Relationship between chargemaster and other AR system files
  • Charge capture principles and methodologies
  • Pricing services
  • Best practices for charges
  • The chargemaster’s relationship to cost reporting

Chapter 3: Chargemaster Management and Maintenance Strategies

  • The team approach to chargemaster maintenance
  • Tracking chargemaster changes for compliance
  • Annual CPT/HCPCS updates
  • Quarterly updates
  • Preparing for a department-by-department review
  • Annual pricing updates
  • Chargemaster change reporting requirements

Chapter 4: Claims and Claim Submission Fundamentals

  • Hospital claims
  • Time limitations on filing claims
  • HIPAA transaction sets
  • Medicare claims flow and processing systems
  • Claim submission fundamentals

Chapter 5: Chargemaster Considerations for Routine Services

  • General medical/surgical nursing units
  • Nursery levels
  • Specialty care units/intensive care units
  • Incidental nursing or bedside procedure charges
  • Outpatients in beds

Chapter 6: Ancillary Services, Part 1

  • Pharmacy and radiopharmaceuticals
  • Drug administration services, blood administration, and oncology
  • Supplies, devices, and implants
  • Laboratory, pathology, and blood products
  • Imaging and therapeutic radiology
  • Perioperative services

Chapter 7: Ancillary Services, Part 2

  • Respiratory and pulmonary services
  • Physical, occupational, and speech-language pathology therapies
  • Emergency, trauma services, and clinic services
  • Cardiology services
  • Labor and delivery

Chapter 8: Coding and Claim Edits

  • Inpatient claim editing software
  • Outpatient claim editing software

Chapter 9: Managed Care Contracting Strategies and Price Transparency

  • Managed care contracts and payer scorecards
  • Price transparency and patient-friendly billing and collection practices

About the Authors

Valerie A. Rinkle, MPA, CHRI, is a lead regulatory specialist and an instructor for HCPro's Revenue Integrity and Chargemaster Boot Camp®, as well as an instructor for HCPro’s Medicare Boot Camp®—Hospital Version and Medicare Boot Camp®—Utilization Review Version. Rinkle is a former hospital revenue cycle director and has over 35 years in the healthcare industry, including over 17 years of consulting experience in which she has spoken and advised on effective operational solutions for compliance with Medicare coverage, payment, and coding regulations.