Hospital Chargemaster Explained

Hospital Chargemaster Explained. The Hospital Chargemaster is a list or database of hospital supplies, medications and services (e.g. 15-min of operating room time) and their associated prices billed to insurance, Medicare and Medicaid. The Chargemaster includes: 1) Department number (unique to each hospital) 2) Charge Code (unique to each hospital) 3) Supply, Medication, Service Description 4) Revenue Code (standardized across hospitals) 5) CPT/HCPCS Code 6) Price (Billed Charges) Unfortunately, each insurance company, Medicare and Medicaid plans accept different combinations of Revenue Codes and CPTs codes... so a combination that may work for Blue Cross will be denied by Cigna. Therefore, hospitals are not told by insurance companies which combinations to use, so they have to just guess and go through a process of trial and error. Hospitals have no rational basis for the prices they charge on the Chargemaster. For example, the medication Oxytocin was marked up from a cost of $0.02 to a price of $264 billed to the insurance company... a 13,200X markup. Even with a 50% discount from the insurance network, that is still at 6,600X markup!! Sources: https://youtu.be/bg0N3WefqPg?feature=shared AHealthcareZ Video on Medical Billing: https://www.youtube.com/live/HndvDMCvpIU?si=4kGMVntEqJRuaaBM AHealthcareZ is 400+ Healthcare Finance Educational Videos. 💥 BOOK: Check out Dr. Bricker’s Book 16 Lessons in the Business of Healing here: https://www.ahealthcarez.com/healthcare-money-campfire-stories-book AHealthcareZ Viewers Include: Employee Benefits Professionals, HR, CFOs, Insurance Brokers, Benefits Consultants, Doctors and Nurses in Leadership Roles, Hospital and Health System Administrators, Health Insurance Carrier and PBM Professionals, Pharma and Med Device Professionals, Academic Professors and Students in Healthcare Administration and Public Health. 90,000+ Views Per Month Across All Platforms. Visit AHealthcareZ.com to Subscribe to the Healthcare Finance Video Newsletter.