What the Chargemaster Contains
The charge description master, commonly called the chargemaster or CDM, is the comprehensive list of billable items and services an organization can charge, including a description, CPT or HCPCS code, revenue code, and price for each item. RHIA candidates should understand the chargemaster as the primary driver of outpatient and ancillary service billing, functioning alongside coded data from the health record.
Charge Capture Workflow
Charge capture is the process of recording every billable service rendered to a patient so it appears on the claim. Charges may be captured automatically through system interfaces, such as an order entering the pharmacy or laboratory system and generating a corresponding charge, or manually entered by clinical or ancillary staff. Breakdowns in this workflow, such as a service performed but never entered into the system, result in lost revenue that is often difficult to detect after the fact.
Chargemaster Maintenance
A dedicated chargemaster coordinator, often within HIM or revenue cycle, must update the chargemaster whenever CPT, HCPCS, or revenue code sets change, which typically occurs annually but can include quarterly updates for new technology codes. A poorly maintained chargemaster leads to claim denials, compliance risk from outdated or invalid codes, and revenue leakage from missed price updates.
Revenue Codes vs. CPT/HCPCS Codes
Revenue codes are four digit codes that identify the general category or department where a service was provided, such as the emergency department or laboratory, and are reported alongside CPT or HCPCS codes on the UB-04 claim form. Candidates should understand that revenue codes alone do not identify the specific service; the CPT or HCPCS code provides that detail.
Charge Reconciliation
Regular charge reconciliation processes compare documented services in the clinical record against charges that actually posted to the patient account, identifying both missed charges and charges posted without supporting documentation, the latter of which represents a significant compliance exposure.
Exam Tip
When a scenario describes a service documented in the chart but never billed, the correct concept being tested is a charge capture failure, distinct from a coding error, since coding applies to diagnoses and procedures already captured as charges or abstracted from the record.