Understanding the Charge Code Master
By Eric New

There are common billing problems that arise from issues with the Charge Code Master (CCM). Sometimes ancillary orders don’t create or generate any charges or the billing office is reviewing a patient’s account and do not see any charges. Maybe medical records is confused about duplicate charges when they try to abstract a patient’s record or accounting is frustrated because revenue is going to the wrong account in the general ledger. When the research is done and the root cause is presented, it usually means that someone changed the CCM. The CCM is one of the most important reference master or table files in any Hospital Information System (HIS). From a financial point of view, it is the primary glue that keeps application modules communicating with one another.

In this article, I will break down the CCM or Charge Description Master (CDM) to help troubleshoot charge issues. The charge code interacts with many other systems, making it a crucial piece of the system. It 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 communication. The charge code ID is the primary identifier and 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 users to categorize the charge code (payment, charge, adjustment, charge explosion and room/bed charges). The National Revenue Value (NRV) 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. Refer to the definitions below to make the right decision regarding charging problems.

1. The charge master communicates with the Paragon Order Management module by supplying the charge code for each order that is chargeable.
2. 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.
3. 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.
4. 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.
5. The charge master communicates with the Claims Administrator (EC2000) by passing the charge code(s) to the Claims UB04 or UB92 forms.
6. 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.
7. 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 would like more information about the CCM call us at 610.444.1233 or email us at vcs@getvitalized.com. You can also visit our website to learn more about the services and solutions offered by VCS at www.getvitalized.com.