On Jan. 1, new Centers for Medicare and Medicaid Services (CMS) rules took effect across the nation, requiring health care organizations to provide pricing information on procedures and services to …
On Jan. 1, new Centers for Medicare and Medicaid Services (CMS) rules took effect across the nation, requiring health care organizations to provide pricing information on procedures and services to the public.
While federal regulations previously required hospitals and other health care providers to make a list of their standard charges available to the public, the new CMS mandate now requires such pricing information to be posted online.
CMS officials proposed the changes to its Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) programs last April and approved them last August.
"The proposed policies in the IPPS and LTCH PPS proposed rule would further advance the agency's priority of creating a patient-centered health care system by achieving greater price transparency, interoperability and significant burden reduction so that hospitals can operate with better flexibility and patients have what they need to become active health care consumers," reads a CMS press release from last year.
The mandated "chargemaster" price list for Cartersville Medical Center (CMC) is available online at www.cartersvillemedical.com/about/legal/detail-price-list.dot. The information posted includes both a "detailed price list" and "average procedure price report," with the latter breaking prices into average charge per case and average Medicare payment per case.
Joe Hagan, assistant vice president of public relations and communications for Hospital Corp. of America's TriStar Division, said CMC has been ahead of the curve for quite some time when it comes to billing transparency.
"Cartersville Medical Center has been providing pricing estimates and information about the billing process online since 2007, and we are complying with the regulation," Hagan said. "We have been focused on pricing transparency for many years because we believe it’s important for patients to be able to make informed choices about their health care and understand their financial obligations."
As of Jan. 1, CMC's detailed price list documents the patient cost of medication and other treatments received at the facility — a 400-milligram tablet of Motrin, for example, is priced at $17 — while the average procedure price report outlines the mean cost of surgeries and other forms of more intensive medical care.
According to the CMC chargemaster list, the average patient undergoing treatment for chest pains, as one example, may anticipate a final bill of $45,652.51, while a patient who undergoes a prostatectomy may expect total charges of $120,527.50.
Those numbers, however, do come with a caveat. As its website notes, CMC does not guarantee the accuracy of the pricing information posted online.
"It may be subsequently updated to reflect, among other things, coding changes required by the [CMS] prior to the next time the list is posted," the website states. "You should understand that a final bill for services rendered at Cartersville Medical Center may differ substantially from the information provided by this website."
Ultimately, Hagan said how much a patient pays for hospital services has more to do with the type of insurance coverage they have than the amount listed on the chargemaster.
"Government programs like Medicare and Medicaid determine how much they reimburse hospitals and insurance plans negotiate rates," he said. "Uninsured patients are eligible for free care through our charity care program or they receive our uninsured discounts, which are similar to the discounts a private insurance plan gets."
In 2017, Hagan said those discounts were expanded to include more uninsured or underinsured patients by capping bills for eligible patients who earn up to 400 percent of the Federal Poverty Level.
Under the new CMS regulations, hospitals are required to update their chargemaster lists "at least annually, or more often as appropriate." Hospitals are allowed to post the required information in the format of their choosing, just as long as said information is accessible on the internet and is machine-readable.
"A hospital is not precluded from posting quality information on price transparency information in addition to its current standard charges in its chargemaster," the CMS noted in a media release. "CMS encourages hospitals to undertake efforts to engage in consumer-friendly communication of their charges to help patients understand what their potential financial liability might be for services they obtain at the hospital and to enable patients to compare charges for similar services across hospitals."