Hospital Charges - What Are We Talking About?
As of January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) is requiring that all hospitals post a comprehensive, online list of charges for services and goods that the hospital provides to its patient. The list, also known as a chargemaster, is intended to help you easily access charge information to improve price transparency. CMS also requires hospitals to post their charge per Diagnostic Related Group (DRG). We have provided that information at the bottom of this page.
Please watch the video below to help you understand what a chargemaster IS – and what it is NOT.
While we fully support efforts to improve pricing transparency, the chargemaster is only a starting point in determining the costs associated with your health care. By itself, the chargemaster is not the most helpful tool for you to comparison-shop between hospitals or to estimate your financial obligation for the healthcare services you receive.
That’s because a chargemaster is not:
- the price you would most likely pay for your care.
- the actual payment rates the hospital receives.
Your out-of-pocket cost for care is not determined by the standard charges listed in the chargemaster for a hospital. Rather, these costs are driven by:
- the agreed-upon rate that your insurance company pays the hospital for the services provided -- which are generally less than the standard charges; and
- the copay, co-insurance or deductible required by your benefit plan.
Individuals without insurance receive a reduced price from the hospital and may also be eligible for financial assistance or charity care.
About YOUR Cost:
The best way to understand your cost for a specific hospital service is to work with your insurer and our patient financial services staff. They can review your personal situation to give you the most accurate estimate, which can vary based on:
- the complexity of your treatment plan;
- the insurer or payer that will be paying for the healthcare services we deliver;
- the length of time you spend in the hospital;
- additional tests or procedures needed; and
- any other unforeseen conditions or circumstances that arise during your care or recovery
Our Single Billing Office can be reached at 215-955-1042.
Below, for your reference, is the chargemaster for our hospitals as well as average charges per Diagnostic Related Group (DRG):
Q: What is price transparency and why is it important?
A: Price transparency is the ability for a healthcare consumer to access provider-specific information on the price of healthcare services, including out-of-pocket costs, regardless of the setting in which those services are delivered.
Q: Why do healthcare consumers need price transparency?
A: Healthcare consumers need price transparency to:
- help them manage their healthcare costs; and
- inform their healthcare decisions through a better understanding of their financial responsibility.
Q: What is the difference between the terms, “Charge/Maximum Price,” “Reimbursement” and “Cost”?
A. The terms “Charge/Maximum Price,” “Reimbursement” and “Cost” mean:
- The “Charge/Maximum Price” is the most a healthcare provider can bill a patient’s insurance for a specific item or service. Insurance reimbursement rates for items and services are often much lower than the provider’s standard charge for such items and services.
- “Reimbursement” is the total amount healthcare providers are paid by the insurer and the patient. The reimbursement amount will differ depending on if a patient has insurance or is eligible for financial assistance, as well as negotiated reimbursement rates between the provider and the insurer.
- “Cost” –
To Providers: The expense incurred to deliver health care services to patients.
To Payers: The amount they pay to providers for services rendered.To Patients: The amount they pay out-of-pocket for health care services. This may include the deductible, co-payment, co-insurance, and amounts that may not be covered by the patient’s insurance policy.
Q: Who sets the hospital’s charges within its chargemaster?
A: Hospitals set the charges within their chargemaster based on a variety of factors, such as operating costs and available insurance reimbursement. Hospitals are required by law to maintain a chargemaster.
Q: Why are there differences in charges for the same items and services between hospitals—even within the same health system?
A: There can be variations, sometimes large ones, in the charges that hospitals set for the same item or service—even within the same health system. This is due to the many factors that go into determining the hospital’s cost of delivering those items and services. Some hospitals have higher cost structures due to the complexity and expense associated with the services they provide (such as trauma, transplant and neonatal intensive care services). Others have higher mission-related costs, such as teaching, research and providing care for low-income populations.
Q: Does the type of health insurance coverage I have impact my costs?
A: Yes. Your health benefit plan sets your out-of-pocket costs (such as deductibles, co-payments, and co-insurance) for services received at a hospital within its network.
Q: If I am uninsured, do I pay the hospital’s full price charge for items and services I receive?
A: No. There are various levels of discounts available depending on your income status. Each hospital’s discount program is different. Please check with the Patient Financial Services team to learn more about the discounts available to you.
Q: What is a National Drug Code (NDC)?
A: The National Drug Code (or NDC), is a unique series of numbers associated with a universal product identifier for human drugs. It identifies the manufacturer, the product, the various dosages and packaging sizes. Therefore, there can be multiple NDCs for the same product description, resulting in various costs and charges for the same drug.
Q: What is a Diagnostic Related Group (DRG) and what is it used for?
A: A Diagnostic Related Group (DRG), is a classification system that categorizes a patient with respect to diagnosis, treatment and length of hospital stay.