IS IT A PROBLEM?
By Eric New
The help desk is calling--the Ancillary Orders did not create OR generate any charges; the
billing office is reviewing a patient's account and no charges are visible; Medical Records is on
the phone--there are duplicate charges when they try to abstract a patient's record; Accounting is
frustrated because revenue is going to the wrong account in the general ledger. Typically, after
the research is completed and the root cause is presented the problem is that someone did something
to the Charge Code Master. The Charge Code Master is one of the most important Reference Master
or Table Files in any Hospital Information System. It is the supporting base that allows a bridge
to connect from one side to another. It should be treated as the critical synapse that keeps
application modules communicating with one another (from a financial point of view).
This article will break down the Charge Code Master (CCM) or Charge Description Master (CDM) to
help solve problems in the future. If you truly stop and think about all of the systems the
charge code interacts/impacts you may be surprised. It is not just a single code that is sent to
a patient's account. The charge code communicates with the General Ledger, Medical Records, Order
Management and Billing (Claims Administrator) within the McKesson Integrated/Interface Products.
For Paragon® and Series2000, the CCM has several important fields that help with its
communication. The charge code id is the primary identifier. This field allows third-party
systems to communicate with the HIS to update a patient's account when a charge is created. The
charge type field allows you to categorize the charge code (payment, charge, adjustment, charge
explosion and room/bed charges). The NRV (National Revenue Value code) allows charge codes to be
grouped by department. Also, this field is one of the links that helps Medical Records with
out-patient charges. The General Ledger Account or Department Number field is used for the prime
account number in the General Ledger Chart of Accounts. The CPT4 (Current Procedural Terminology)
field is the other link that Medical Records uses for outpatient charging and how professional
charging/services are identified to the Payor(s). The charge amount field(s) allows the user to
perform tiered pricing. There is a cost amount field that is used on the Paragon® Case Mix
reports to do variances against the price. The price and description override fields allows the
user to change the price and description when rejected charges have to be posted to a Patient
account or a Miscellaneous charge needs a detailed description within the Paragon® Patient
Management module.
To summarize, the following chart should help in understanding the interaction of the CCM
within McKesson's® application structure. So when you are troubleshooting a charging problem
refer to the definitions below to make the right decision.
The Charge Master communicates with the Paragon® Order Management module by supplying the
charge code for each order that is chargeable.
The Charge Master communicates with the Paragon® Medical Records module by providing CPT4 and
NRV codes in order for the encoder to properly calculate inpatient and out-patient reimbursements.
The Charge Master communicates with the Paragon® Patient Management module by posting charge
code, NRV code, CPT4 code and other important fields for future reporting.
The Charge Master communicates with the Paragon® General Ledger module by passing the charge
code revenue to the department GL account and/or sub account when posted.
The Charge Master communicates with the Claims Administrator (EC2000) by passing the charge
code(s) to the Claims UB04 or UB92 forms.
The Charge Master communicates with the Pathways Compliance Advisor by interfacing the charge
code to the procedure codes to retrieve the ABN (advanced beneficiary notification) for proper
services.
The Charge Master communicates with the Pathways Contract Manager by interfacing the charge
code to post adjustment(s) to the patient's account.
If you need more information or have any questions please feel free to contact VCS at
vcs@getvitalized.com.