Chargemaster Optimization
Built With You. Designed for Your Community.
Somewhere in your chargemaster right now, a handful of codes are quietly costing you significant revenue. That’s okay, and it’s completely normal. A CDM runs thousands of line items deep, and reviewing it closely takes a level of focus most rural hospitals simply can’t spare on top of running the hospital day-to-day. Your team wears more hats than most, and something this detailed is easy to let slide when there’s always something more urgent in front of you.
Many rural facilities haven’t reviewed their CDM in 4-5 years or even a decade. This is a totally understandable and normal practice within rural health. We run into this frequently, so we partner directly with your team to develop a defensible, data-backed CDM strategy centered on your hospital’s priorities and your community’s needs.
Our work comes with a 2:1 guarantee. It’s built to pay for itself.
What Is a Chargemaster, and Why Does It Matter?
A Chargemaster, or Charge Description Master (CDM), is the master list of every billable service, procedure, supply, and item your hospital provides, along with their associated codes and prices. It’s the foundation your entire revenue cycle is built on.
When a CDM falls out of date, the effects show up quickly: missed reimbursements, claim denials due to charge inconsistencies, and compliance risks during audits. CMS updates billing rules quarterly, and most rural hospitals don’t have a dedicated CDM analyst to track every change, so pricing gaps quietly compound over months or years.
For Critical Access Hospitals operating on thin margins, an outdated chargemaster isn’t an administrative footnote. It’s lost revenue your hospital has already earned but isn’t collecting.
Why Rural Hospitals Choose REDi Health
- A Customized Approach, Every Time
Every chargemaster engagement begins with understanding your hospital’s unique services, patient population, and financial goals. We tailor our recommendations to your team—not a one-size-fits-all playbook.
- Transparent Peer Benchmarking and Data You Can Trust
See how your pricing compares to similarly sized peer hospitals. Our benchmarking process gives you clear, data-backed insights so every recommendation is easy to understand and defend.
- Strategic Pricing Recommendations
We look at pricing code by code, and sometimes that means raising a rate, sometimes lowering one, even if it trims margin on paper, because keeping volume often serves the hospital better than a higher price that pushes patients elsewhere. The goal is pricing that supports overall financial performance while staying competitive enough that patients keep choosing local care.
- Implementation Support Beyond the Report
Recommendations only create value when they’re put into practice. We work alongside your team to implement approved changes, answer questions, and help ensure a smooth transition.
Our Approach to Chargemaster Optimization
01
Discovery
We start by listening. A one-on-one discovery session helps us understand your leadership initiatives, operational realities, and community considerations, because the right pricing strategy looks different for every hospital.
02
Analysis
We start with your chargemaster in a standardized format and load it into Vitalware for our initial analysis. The initial reports package includes the most recent CPT/HCPCS code updates, helping us identify and prioritize the biggest risks and opportunities for your revenue.
03
Benchmarking
We compare your pricing against Medicare rates, national pricing benchmarks, and your choice of local peer facilities. We’ll meet regularly to review the data, discuss key decision points, and identify the biggest revenue opportunities based on your market.
04
Strategic recommendations
Pricing recommendations are developed collaboratively through in-depth discussions—not handed down as a one-size-fits-all solution. We also provide transparency and education around pricing approaches and guidelines.
05
Delivery & Support
You’ll receive a summary of our recommendations, implementation-ready data in your preferred format, and information you can confidently provide to payors. Our support continues through implementation as we track progress with your team, help ensure you’re seeing the expected financial results, and adjust in real time when needed.
Two Ways to Engage REDi Health
One-Time Analysis (Most Popular)
A complete, single-pass review. We evaluate your full chargemaster, deliver specific recommendations, and hand you implementation guidance your team can act on directly. This is a good introduction to REDi Health and where we earn your trust.
Maintenance Subscription
You choose the level of engagement that works best for your hospital. Whether you prefer an annual comprehensive review, quarterly service-line reviews, or a customized schedule with a certain level of involvement and touchpoints, we’ll tailor a maintenance plan to fit your team’s needs and resources.
These maintenance subscriptions combine ongoing pricing assessments, focused code reviews, collaborative guidance, and actionable reporting to keep your chargemaster performing at its best. By identifying opportunities early and making timely adjustments, we help reduce downstream denials, maintain an accurate CDM, and improve the effectiveness of yearly reviews.
What We Evaluate in Your CDM
Our work is grounded in strong analytics and practical strategy:
- CDM Completeness Analysis to identify missing, incorrect, or expired codes
- CDM Benchmarking against Medicare-allowed rates, peer competitors, similar-sized facilities, Critical Access Hospitals, and national datasets
- Strategic Pricing Guidance tailored to service mix, utilization, and leadership goals
- New Code Review to assess pricing impact and implementation strategy
- Community Impact Considerations to ensure pricing decisions support access to care
Peer comparison data can be provided to support executive discussions and board-level review, so you walk into that conversation with answers, not assumptions.
Expected Outcomes
Throughout the engagement, we measure projected financial impact against relevant benchmarks, with community considerations front and center.
At the conclusion of the project, you receive:
- A comprehensive summary of findings and recommendations
- A calculated financial impact analysis
- Supporting benchmark data
- Optional board presentation support
- Implementation support
- A six-month post-engagement review to assess revenue impact and compare results against projected outcomes
What this means for your hospital:
- Stronger net revenue through accurate charge capture and clean billing, capturing reimbursement you've already earned
- Fewer audit and compliance surprises, from a proactive CDM strategy instead of reactive fixes
- Fewer denials, from resolving the charge inconsistencies that slow your revenue cycle down
- Improved financial stability, shown through before-and-after implementation metrics
If you are a State Office that engages REDi Health, you’ll receive reporting built around your program’s priorities.
We collaborate with your team to understand your reporting goals and build deliverables that support them. Whether you’re reporting to HRSA, state leadership, legislators, hospital boards, funding partners, or participating hospitals, we tailor our reporting to meet your needs.
Don't Just Take Our Word For It
We couldn't have done this on our own....this is harder and more complex than we can do on our own. We haven't ever done a review of our Chargemaster that is this comprehensive. This 16 million means a lot to us.
Case Study: 17- Bed Hospital in Utah
In one recent chargemaster review, from a full CDM with 10,000 to 15,000 line items, we identified around 275 codes for adjustment, resulting in an overall increase of roughly 2%. This review was conservative and deliberate by the client’s own choice, and it was still worth an estimated $1 million in additional collectible revenue in year one.
A True Partnership
What makes REDi Health different is how we work. Rural hospitals need a partner who understands what it’s like to operate with a small team, a tight budget, and a community counting on you to get this right. That understanding shapes everything we do.
We collaborate with the departments affected by change, so your team understands the reasoning behind every recommendation. Pricing decisions at a rural hospital carry weight beyond the balance sheet, so we shape our work around your specific initiatives and prioritize what matters most to your community.
That collaboration is what helps build internal understanding, so your team can confidently sustain the strategy long after our engagement ends. Our goal is to leave you stronger than we found you.
Other Recommended Services for Financial Stability
A chargemaster review is just the beginning of strengthening your revenue cycle. Here are the services we most often pair it with to answer the rest.
Denials IQ
Surfaces the patterns behind your denials, so you know which codes, payers, or departments are driving the losses instead of guessing.
Denials Navigator
Works your denials queue directly, prioritizing and resolving the claims most likely to be recovered.
Contracts IQ
Confirms payers are reimbursing according to your actual contract terms, catching underpayments a chargemaster review alone won't surface.
Contracts Navigator
Reviews your payer contracts against current terms and market benchmarks, so you know where you're underpriced before you ever sit down at the negotiating table.
FAQs
We recommend beginning a chargemaster review approximately six months before your planned CDM implementation date or any major pricing changes. Starting early allows time for a thorough analysis, internal review, and thoughtful implementation of recommendations before changes take effect. This proactive approach helps ensure your chargemaster is accurate, competitive, and aligned with your hospital’s financial goals when updates go live.
However, a review can be started at any time, especially if you have concerns about pricing accuracy, missed revenue opportunities, or outdated charges.
Most engagements run 8 to 12 weeks start to finish. The biggest variable is how quickly we receive your CDM file. Facilities should take into consideration the payor notification requirements at least 30 days before the project completion date.
We typically work with your CFO, revenue cycle leader, and the person who manages your chargemaster. Most of the work is handled by our team, with periodic review meetings and questions for yours, minimizing the time commitment.
We provide a straightforward data request tailored to your billing and patient accounting system and work with your team to securely pull the information needed. Most hospitals can provide the required files through standard system exports. If your facility is part of a shared EHR instance, we’ll coordinate with your health system or EHR team to obtain the necessary data. That’s a common scenario for us, and one we’re well equipped to navigate.
We compare your CDM against the Medicare base rate floor, regional and national peer rates, and your own volume data, and then apply a minimum-use threshold so that recommendations focus on codes that matter to your bottom line.
No. We target high-volume codes where a price change actually moves revenue, and we typically cap the average annual increase at around 5%, depending on your facility’s payor contracts. Low-volume codes are usually left alone.
That’s very common. Most rural facilities wait 4 to 5 years between reviews (We also have clients who haven’t updated theirs in over a decade; regardless, we are here to help), which is exactly where the missed revenue accumulates. A one-time analysis will show you where you stand before you commit to anything ongoing.
Ready to strengthen your chargemaster strategy?
Let's start with a conversation about your hospital's priorities and where opportunity may exist. We'll walk through how a collaborative, data-backed approach can help you move forward with clarity and confidence.
