Going into effect Jan. 1, the Inpatient Prospective Payment System rule is part of a Medicare program intended to enhance pricing transparency in the health care market and make electronic records more readily available.
Ballad Health Director of Communications Teresa Hicks said in an email that Ballad will conform to the new rule by posting hospital “chargemaster” data to its website, www.balladhealth.org, on Jan. 1.
Also known as a CDM, chargemaster is a term used to describe the comprehensive listing of items that can be billed by a hospital to a payer, patient or facility. According to a Feb. 9, 2018, article in RevCycleIntelligence, each hospital determines its own chargemaster prices for the thousands of services performed by providers, and hospitals tend to set those prices based on a variety of factors, including competition.
However, Hicks said the chargemaster prices cannot be used by patients with health insurance to accurately estimate their out-of-pocket costs.
“Chargemasters cannot be used to accurately estimate out-of-pocket costs for individual patients because hospital reimbursements are set by what the insurer is willing to pay and each individual’s specific insurance policy determines the amount of their copayment and deductible,” Hicks said via an email to the Johnson City Press.
According to Ballad Health’s charity policy, patients without insurance can receive discounts on services, depending on their income level.
Patients with an income below 450 percent of the federal poverty level are charged on a sliding-fee scale, while patients with an income below 225 percent of the federal poverty level are eligible for free care from Ballad Health.
According to a Health Affairs study cited in the same RevCycleIntelligence article, an average hospital with more than 50 beds had a charge-to-cost ratio of 4.32, which meant that hospitals charged patients $432 for services that actually cost just $100.
Anyone wanting an individualized estimate of out-of-pocket costs for a procedure or service at Ballad Health is encouraged to call 423-431-1776 during regular business hours to speak with a representative.