Chargemaster and Charge Capture

A federal judge dismissed the American Hospital Association’s challenge to CMS' Hospital Price Transparency Requirements final rule. The final rule, effective January 1, 2021, will require hospitals to disclose charges they privately negotiate with commercial payers, among other requirements.

Q. Nearly half (48%) of respondents structure their chargemaster maintenance by assigning a team to this responsibility. What should teams be aware of when maintaining their chargemaster?

A. Chargemaster teams should have representation from various areas, including ancillary departments, compliance, coding/HIM, finance, physician leadership, if possible, and of course, revenue integrity. These teams should be cognizant of the changing healthcare landscape both internally and externally—this year especially due to COVID-19—and the impact this has had or may have on chargemaster structure, pricing, charge capture, and overall compliance. Moreover, they should be positioned to take a proactive rather than reactive approach to the constant barrage of data, new code sets, and shift to a “hospital without walls” mentality.

Calling all Revenue Integrity Investigators! Revenue Integrity Week (June 1‒5) is just days away and NAHRI has a lot in store to ensure we all recognize the dedication of revenue integrity professionals while taking some time for education, networking, and most importantly fun.

CMS’ fiscal year (FY) 2021 Inpatient Prospective Payment System (IPPS) proposed rule, released May 11, proposes new price transparency requirements focused on reporting of negotiated charges.

The next episode of NAHRI’s new podcast, The Revenue Integrity Show, airs Thursday, May 7, at 3 p.m. Eastern. This episode dives into the impact of COVID-19 on revenue integrity from the perspective of a physician and an operations expert.

Take a closer look at how price transparency requirements are transforming revenue integrity and how you can prepare.