CRCR Charge Description Master (CDM) and Price Transparency

Question 1

What is a Charge Description Master (CDM)?

Accepted Answer

A comprehensive database containing every service, supply, and procedure a hospital can bill, along with the associated charge, revenue code, and procedure code

Answer

The CDM (also called the chargemaster) is the facility's internal price list — every billable item has a description, HCPCS/CPT code, revenue code, and charge amount. It is the foundation from which all claims are generated.

Question 2

Under the CMS Hospital Price Transparency rule (effective January 1, 2021), hospitals are required to publicly post:

Accepted Answer

A machine-readable file of all standard charges and a consumer-friendly display of shoppable services

Answer

CMS requires hospitals to post two things: (1) a comprehensive machine-readable file with all standard charges for every item/service, and (2) a patient-friendly display of at least 300 shoppable services with payer-negotiated rates and self-pay discounted rates.

Question 3

A CDM audit is primarily conducted to:

Accepted Answer

Identify outdated, incorrect, or missing charge codes that could lead to underpayment, overbilling, or compliance risk

Answer

Regular CDM audits catch coding errors (wrong CPT/HCPCS), obsolete codes, missing new services, and pricing anomalies — all of which can result in claim denials, compliance violations, or lost revenue.

Question 4

The No Surprises Act (effective January 1, 2022) primarily protects patients from:

Accepted Answer

Unexpected out-of-network bills for emergency services or services received from out-of-network providers at in-network facilities without prior notice

Answer

The No Surprises Act bans surprise medical bills in emergencies and when patients unknowingly receive care from out-of-network providers at in-network facilities. It requires Good Faith Estimates for uninsured/self-pay patients and limits patient cost-sharing to in-network amounts.

Question 5

Which revenue code on a UB-04 claim form indicates the type of service and is required to map CDM charges to the correct billing category?

Accepted Answer

A three- or four-digit code that classifies the accommodation or ancillary service (e.g., 0450 for emergency room, 0270 for medical/surgical supplies)

Answer

Revenue codes are three- or four-digit numeric codes on the UB-04 that classify the department or type of service generating the charge. Each CDM line item must have a valid revenue code to route the charge correctly on the claim.

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR - Certified Revenue Cycle Representative Program Practice Test

CRCR Charge Description Master (CDM) and Price Transparency