Hospital Chargemaster Explained

[@PaulKnouff]

Been a doctor for 20 years and just now starting to understand how the system cheats patients and doctors, Thank you for this video

[@ahealthcarez]

Thank you for watching.

[@tdog158]

Thank you Dr Bricker for making more transparent the system around the chargemaster. It is really awful that some Americans are forced into paying such extreme profits. I appreciate your sharing how it makes you feel.

[@ahealthcarez]

Thank you for watching.

[@ClutchSmada88]

I have worked for an independent TPA since 2009. It's criminal this video only has around 2k views. Every American who participates in paying for insurance or heatlhcare needs to know this.

[@ahealthcarez]

Thank you for your support.

[@fairsi1]

Working in a health insurance company for more than 10 years, your videos helps me understand the whole picture of the industry. Thank you! Right now the denied claims are a big issue among contract negotiations.

[@ahealthcarez]

Thank you for the context.

[@christophermoriarty7843]

Best channel on KZbin for this type of info for physicians!

[@ahealthcarez]

Thank you for your feedback.

[@thetrueyorker]

Amazing presentation, I guess it helps the healthcare Mafia to keep things murky and keep the prices jacked up.

[@ahealthcarez]

Thank you for watching and for your comment.

[@murali_k]

Thanks for the video. Watching your videos from the other part of world India. I am a business system analyst on the softwate development team that work on the claims adjudication system for one of the commercial payer. This video gives me another perspective of how hospital billing charge master works and our system approves or denies them. Thanks for the effort.

[@ahealthcarez]

Thank you for watching.

[@erica5098]

Another Great Video, thank you for what you do.

[@ahealthcarez]

Thank you for watching.

[@adityad1226]

Wonderful videos as usual and very well summarized. I will be sharing this with several colleagues. I work in this industry and the arbitrary nature of "billed charges" drives me insane. Part of what Vitalware does is to maximize Medicare/Medicaid/Commercial reimbursement by looking at the contracts and what the various insurers will pay. For example Medicare might only pay the lesser of X% or $Y for a given CPT/HCPCS, whereas BCBS will pay upto 25% of billed charges. The change in prices year over year is often a combination of the above and a market analysis of what other hospitals in the area are charging combined with the particular hospital's service/insurer mix. Wouldn't it be nice if CMS created and enforced rules that did not allow for variation between insurers on the UB with Rev Code/CPT combination or even reimbursement mechanisms? This is something the Netherlands does with its "DBC" or Diagnose Behandeling Combinatie (diagnosis-treatment-combination) system which is very similar to DRGs but includes outpatient care across multiple episodes of related care.

[@thomass5169]

My wife was just charged $25,000 for a pelvic CT scan at our local public hospital. They want an additional $5000 plus just for sitting in the emergency room. Total bill was more than $32,000. This is totally unsustainable for almost everyone. by the way, we got a price for a CT scan across the street from the hospital for less than $300. This is devastating.

[@ahealthcarez]

Ugh! Thank you for sharing your experience.

[@thomass5169]

@@ahealthcarez I will be calling the hospital administrator in the morning. Asking, how is this justified? I will offer .10 cents on the dollar, which I think is generous.

[@SureshKumar-xs2sw]

Dr. Eric awesome information for medical billers. Why HIPAA is not interfering here to standardize the Revenue code, of course first two column is for hospital specific, but remaining part of the combination is out of the hospital where HIPAA can have control.

[@mytube785]

Hi Dr. Bricker: another great video! I wonder if you’d put together a curriculum for healthcare finances ?

[@ahealthcarez]

Yes. Here it is: kzbin.info/aero/PLUQ9-A6uTgNQLa-7KDqdSW8uYgi2hJCct&feature=shared

[@mytube785]

@ great, thanks !

[@GH-zs9fj]

I would guess this puzzle is contributing to the closure of rural hospitals. In small hospitals, you can not expect one chargemaster and 1-3 coder assistants to accurately determine which exact code individual insurance companies determine to be acceptable. Many years back, while working in public health, I had to reference the ICD-9 manual. That one manual alone was approximately 4 inches thick and only included codes for diseases, conditions, and injuries. Rural hosptals probably do not have the luxury of absorbing the cost of one person making 2 errors per week, even if these numbers are within the margin of error for their job description. Also, now that this data is computerized, I wonder how often the vendors to whom the hospitals contract are audited for accuracy.

[@ahealthcarez]

Thank you for sharing your thoughts.

[@StephenGriffith-j1d]

13,200x markup! x=.02 ∴ y=264.00 Incredible!

[@ev1836]

Can you make a new video about value based care and health equity? Would love to hear your thoughts on how health equity impacts star ratings

[@ahealthcarez]

Thank you for your suggestion.

[@hecksherian]

For professional fee, the charge price has much less ( or no?) impact on reimbursement/cost to insurances/pt , is that correct? Since reimbursement is based on a negotiated rate of what Medicare reimburses…. Or am I way off? Thanks so much for all you

[@ahealthcarez]

You are correct. Thank you for watching.

[@StephenGriffith-j1d]

This smoothe brain is getting some wrinkles.

[@GH-zs9fj]

I would guess this puzzle is contributing to the closure of rural hospitals. In small hospitals, you can not expect one chargemaster and 1-3 coder assistants to accurately determine which exact code individual insurance companies determine to be acceptable. Many years back, while working in public health, I had to reference the ICD-9 manual. That one manual alone was approximately 4 inches thick and only included codes for diseases, conditions, and injuries. Rural hosptals probably do not have the luxury of absorbing the cost of one person making 2 errors per week, even if these numbers are within the margin of error for their job description. Also, now that this data is computerized, I wonder how often the vendors to whom the hospitals contract are audited for accuracy.