06 / Revenue Integrity
Chargemaster Review
Every claim starts in the chargemaster. When a line is wrong there, it is wrong on every claim that uses it. We find those lines, tie them to the denials and lost revenue they cause, and fix them with your team.
Up to 1%
Of net charges lost to charge integrity leakage, per HFMA
$5M/year
What that leakage looks like at a hospital with $500M in net revenue
4x/year
HCPCS codes and NCCI edits change every quarter. Your CDM has to keep up.
Apr 2026
CMS began enforcing the updated hospital price transparency rules
Why It Matters
A chargemaster drifts a little every quarter. Nobody notices until the denials pile up.
A hospital CDM holds thousands of lines, and the rules around it change constantly: CPT every January, HCPCS and NCCI edits every quarter, payer policies whenever they like. Each change that does not reach the CDM becomes lost charges, underpayments or denials.
The CDM is also now a public document. Your price transparency files are built from it, CMS expects a named senior official to attest they are accurate, and patients and payers compare your prices against your neighbors.
Our Approach
“We start from your remits, not your spreadsheet. If a CDM line is costing you money, the denials already show it.”
Most CDM reviews check lines against code books and stop. We also trace denials back to the line that caused them, using the same CARC and RARC knowledge base behind the 6QD Denial Playbook. You see which fixes pay for themselves first.
About the Denial PlaybookWhat We Review
Every line, checked eight ways.
Code validity
Every CPT and HCPCS code checked against the current code sets. Deleted codes, replaced codes and codes that never belonged on a facility claim come out before a payer rejects them.
Revenue codes and modifiers
Revenue code to HCPCS pairings, hardcoded modifiers and units of service. A wrong pairing or a modifier that does not fit the procedure turns into a denial on every claim that uses the line.
Pharmacy and NDC
HCPCS to NDC crosswalks, billing units against NDC units, and drugs with no valid NDC on file. Missing or invalid NDCs are one of the most common denials we see in the Denial Playbook.
Supplies and implants
Which supplies are separately chargeable, device and pass-through codes, and items that are charged but never paid because they are bundled. We separate real revenue from noise.
Pricing
Consistency of your pricing method, lines priced below what Medicare or your contracts pay, and how lesser-of contract terms interact with your charges. A charge set too low can cap what you are paid.
Duplicates and descriptions
Duplicate and inactive lines, departments using different lines for the same service, and descriptions clinicians cannot match to what they did. A cleaner CDM is easier to charge from correctly.
Price transparency
Your machine-readable file and shoppable services list are built from the CDM. We check they match, that the 2026 attestation and data elements are in place, and that a senior official can sign off with confidence.
Charge capture and routing
How orders become charges, which charges arrive late, and where charges go missing between departments and the bill. The best CDM in the world does not help if the charge never drops.
From Denial to Root Cause
Denials that start in the chargemaster.
These combinations show up again and again in the Denial Playbook. Each one usually traces back to a single CDM line, which means one fix stops every future denial like it.
| Denial codes | What the payer said | Common CDM cause |
|---|---|---|
| CARC 4 | Procedure code inconsistent with the modifier used | Hardcoded modifier or wrong modifier on the CDM line |
| CARC 16 + M119 | Missing, invalid or deactivated NDC | Pharmacy CDM lines with no current NDC crosswalk |
| CARC 16 + M20 | Missing or invalid HCPCS code | Deleted or outdated HCPCS code still active in the CDM |
| CARC 16 + M53 | Missing or invalid days or units of service | Billing units on the line do not match the code definition |
| CARC 97 + M15 | Services billed separately that are part of one procedure | Separately chargeable lines that should be bundled |
| CARC 234 + M2 | Service not paid separately for an inpatient | Charge routing that sends inpatient items as separate lines |
How We Engage
A one-time cleanup, then a CDM that stays clean.
Extract
We pull your CDM, twelve months of claims and remits, and your top payer contracts. No new software is needed on your side.
Validate
Automated checks run every line against current code sets, edits and payer rules. Our analysts review what the automation flags and add the context.
Correct
You get a redline of every change with the reason and the dollar impact. Pharmacy, supply chain and department leaders sign off before anything changes.
Sustain
A quarterly maintenance calendar, a CDM committee charter and automated checks that flag new deletions each quarter, so the CDM stays clean after we leave.
Find out what your chargemaster is costing you.
Send us a de-identified sample of your CDM and recent denials and we will show you the first problems we would fix, before you commit to a full review.