CHARGEMASTER

Steven Brill wrote a very good article on our health care system recently in Time Magazine. If you haven’t read it, you might want to take a look. The information can profoundly effect your finances if you ever need hospital care.

In the hospital where I worked twenty years ago, we technologists went to Central Service and got the supplies we needed. Central Service wrote down the cost of the items and charged them back to the department – (Radiology). Today, everything that is used on or for you is charged to you via a system called chargemaster.

Scripps Hospital, a private, nonprofit health system in San Diego, California says . . . “chargemaster is a comprehensive and hospital-specific listing of each item that could be billed to a patient, payers or other health care provider. Most procedures are comprised of multiple components – your hospital room charge, laboratory charges, diagnostics, pharmacy, therapy, etc.”

The price of every single item used, ie, a needle, a piece of gauze, a catheter, is computed by chargemaster in some magical way and billed to you.

Jeff Pilato, director of revenue cycle at coding firm HRS explained that chargemaster . . . “is the hospital’s electronic list of all services, procedures and supplies charged to payors. [It], is the central mechanism of the revenue cycle. All charges for services and supplies, whether inpatient or outpatient, reside in the chargemaster.”

I went to the medical billing answers website for further clarification. It told me to take a look at this page to see an example of how the codes can be broken down. When I clicked on the link this is what came up.

404 – 找不到檔案或目錄。

您要尋找的資源可能已移除、名稱已變更，或暫時無法使用。

Seriously – though Chinese, not Greek.

To add to the confusion, Mr. Pilato explained that every charge must be connected to ICD-10, International Classifications of Diseases. (The 10 refers to the number of times this has been reviewed.) A big problem arises because often, inpatient chargemaster codes don’t match the ICD codes.

To complicate matters even more, the chargemaster charges are totally unrealistic For example, you may be charged $1.50 for one aspirin, (100 at Walgreen’s for $5.99) – or $333 for a $23 bedside chest x-ray. Not for profit hospital administrators rationalize these outrageous charges by saying the excesses covers the cost of charity patients. This, of course, is nonsense. We taxpayers do that.

Steven Brill found there seemed to be no rhyme or reason why chargemaster came up with the prices it assigns to items . . .”that are the basis for hundreds of billions of dollars in health care bills.”

The government and insurance companies negotiate the cost of drugs and equipment for patients covered by Medicare. What if you aren’t yet 65? Even if you have insurance, it may prove inadequate, and you will be billed and required to pay all the charges, (unless you can find someone who knows how to arbitrate those bills.)

In addition, I could find no correlation between what drug companies charge the hospital for medications and what the hospital charges you.

I won’t even go into the question of why doctors order many more cash-generating, expensive tests than needed or the why some hospitals refuse to share multimillion dollar pieces of equipment such as  MRI, CT  and PET scanners.

Finally, chargemaster charges are not regulated. They are different in every hospital. Some hospital administrators call them irrelevant and another says they can’t explain them but that they seem to go up automatically. Is chargemaster simply a cash cow allowing administrators to draw million dollar paychecks?

Steven Brill writes that hospitals are . . . “supposed to be government-sanctioned institutions accountable to the public.” He believes chargemaster should be outlawed.

I think so, too.