As of January 1, 2021, hospitals are required to be in compliance with the hospital price transparency requirements set forth in the CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates: Price Transparency Requirements for Hospitals to Make Standard Charges Public (CMS-1717-F2), herein referred to as the “Hospital Price Transparency Final Rule”. This Rule implements Section 2718(e) of the Public Health Service Act and requires most hospitals to make public their standard charges (as defined at 45 CFR § 180.20) online in two ways:
1. A comprehensive machine-readable file that includes the following standard charges for all hospital items and services: gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges; and
2. A consumer-friendly display that includes the following standard charges for at least 300 ‘shoppable’ services (or as many as the hospital provides if less than 300) that are grouped with charges for ancillary services that are customarily provided by the hospital: discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.
As an alternative to making public your standard charges for shoppable services in accordance with 45 CFR § 180.60(a)(1) (as outlined in the steps below), you may instead offer an internet-based price estimator tool as described in 45 CFR § 180.60(a)(2). If your hospital chooses this alternative, the price estimator tool must:
• Provide estimates for as many of the 70 CMS-specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as is necessary for a combined total of at least 300 shoppable services.
• Allow healthcare consumers to, at the time they use the tool, obtain an estimate of the amount they will be obligated to pay the hospital for the shoppable service.
• Be prominently displayed on the hospital’s website and accessible to the public without charge and without having to register or establish a user account or password.
Inspira meets the requirement for a consumer-friendly display with the cost estimation tool referenced above.
Inspira is meeting the requirement pertaining to the machine-readable file for all hospital items and services via the link below.
This hospital determines its standard charges for patient services with the use of a chargemaster or similar system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for services provided at this hospital.
The chargemaster is similar in concept to the manufacturer’s suggested retail price (MSRP) on a vehicle. It is the starting price of each service performed and goods consumed associated with the individual patient’s treatment. The chargemaster rates are updated from time to time to accurately reflect the hospital’s expenses to operate.
Standard charges shown in the attached file do not necessarily reflect what a patient may pay. Government insurance plans such as Medicare and Medicaid do not pay the chargemaster rates, but rather have their own set rates which hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with managed care payors and may or may not reflect the standard charges. The negotiated payer rates are reflected in the file as required by CMS. Patients without commercial insurance or not covered by a government health care plan should contact the hospital prior to a procedure to discuss charges, alternative pricing, and payment terms. The hospital does have a separate set of rates for those patients that are uninsured that is a significant discount from the chargemaster rate and reflects current New Jersey regulations pertaining to billing the uninsured. That rate is also published in this file as required by the hospital price transparency final rule.
Questions and comments should be directed to the Inspira patient business services office at (856)575-4780.
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