The<unk>  may be alternatively referred to as the "charge master", "hospital<unk> ", or the "charge description master" (CDM). It is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. It is described as "the central mechanism of the revenue cycle" of a hospital.<unk> s include thousands of hospital services, medical procedures, equipment fees, drugs, supplies, and diagnostic evaluations such as imaging and blood tests. Each item in the<unk>  is assigned a unique identifier code and a set price that are used to generate patient bills. Every hospital system maintains its own<unk> . Usually, hospitals regard their<unk> , alongside the medical codes that catalogue the billing items, as a trade secret that is central to their business, and state laws and courts have often accepted the view that these are proprietary information. The procedure of developing, maintaining, and monitoring the<unk>  and its pricing scheme often necessitates multiple hospital employees working under the supervision of a<unk>  coordinator", a "charge master manager", or others in the health care system's operations or administrative support areas frequently called a "charge master team". Ultimate responsibility for ensuring accuracy of the<unk>  rests with each hospital's chief financial officer, compliance officer, and hospital Board. Approximately forty percent of hospitals pay outside companies to help create and then adapt their<unk> s on a yearly basis. According to Essentials of Managed Health Care, as of 2012 the<unk>  file typically included between 20,000 and 50,000 price definitions. The Lewin Group analyzed utilization of the<unk>  and found that a low proportion of hospitals carried out regular reviews of their<unk>  implementation. Costs for patients maintained on the<unk>  differ greatly from hospital to hospital. Authors J. Patrick Rooney and Dan Perrin note in their book America's Health Care Crisis Solved, "Charge-master rates, in reality, serve as nothing more than the starting point for negotiations" with the payer. The impact of the<unk>  is such that those with good insurance or better access to means to afford quality healthcare pay the least for that care, whereas conversely uninsured, and others who pay out-of-pocket for healthcare pay the full<unk>  listed price for the same services.
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