BAXTER REGIONAL PRICE TRANSPARENCY

In the Fiscal Year 2015 IPPS/LTCH proposed rule and final rule (79 FR 28169 and 79 FR 50146, respectively), CMS noted that section 2718(e) of the Public Health Service Act, which was enacted as part of the Affordable Care Act, requires that each hospital operating within the United States, for each year, establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital.

Please contact a Baxter Regional financial counselor if you would like an estimate of your out-of-pocket cost. (870) 508-1080.

A chargemaster is a hospital’s list of charges for services and items. Charges are not the same as prices and almost no one ever pays the actual charge for an item or service at a hospital. The actual price that a patient or insurance will pay depends upon what insurance the patient has, if any, or if the patient is a Medicare or Medicaid beneficiary.

Medicare, for instance, pays in two different ways. Medicare has a maximum allowable amount that can be billed for an item or service, which is the most that Medicare will pay, regardless of what the actual charge is. The second way Medicare may pay for a service is through a Diagnosis Related Group (DRG), which is essentially a lump payment for all the services associated with that diagnosis during a particular episode of care. Medicare pays a set amount for the DRG, regardless of whether a hospital provides services or items in excess of the amount that Medicare pays for that DRG. If a hospital exceeds that amount in treating a patient, those services and items in excess are not reimbursed. However, if a hospital can provide those services for less cost than the lump sum, the payment is not decreased. Some services are DRGs and others are separately reimbursable. All of the items and services are still maintained individually on the chargemaster.

Please contact a Baxter Regional financial counselor if you would like an estimate of your out-of-pocket cost. (870) 508-1080.

If a patient has private insurance, such as UnitedHealthcare, or Humana, for example, the charges still do not reflect the price that the insurer or the patient will pay. Insurance companies have contracts with hospitals and other healthcare providers which define the terms of reimbursement/payment for services. The details of those contracts are what determine the amount that both the insurer and the patient will pay. Additionally, the specific details of a patient’s insurance policy and plan will determine what amount the patient owes for services.

Finally, if a patient is uninsured, the amount owed by the patient will be a discounted portion of total charges on the account. This discount is 40%. So, for a service with a listed charge of $1000, a self-pay patient will owe $600 if payment is paid in full by the due date.

CLICK TO DOWNLOAD THE BAXTER REGIONAL CHARGE MASTER

CLICK TO DOWNLOAD THE BAXTER REGIONAL AVERAGE CHARGES PER DRG
(Note: These are the average charges per DRG and are not necessarily an accurate reflection of what your individual bill will be. DRGs are quite different between insurers and dependent upon certain conditions which are too complex to account for in their entirety in this document. Patients are encouraged to contact our Patient Financial Services department for more detailed estimates of their potential bill for services).

CLICK TO DOWNLOAD PHARMACY CHARGE MASTER

Please contact a Baxter Regional financial counselor if you would like an estimate of your out-of-pocket cost. (870) 508-1080.

Want more information?
Download the HFMA Consumer Guide to Healthcare Prices - ENGLISH
Download the HFMA Consumer Guide to Healthcare Prices - SPANISH

Download the HFMA Guide to Avoiding Surprises in Your Medical Bills - ENGLISH
Download the HFMA Guide to Avoiding Surprises in Your Medical Bills - SPANISH