Hospital Charges / Price Transparency

OVERVIEW 

In compliance with the Centers for Medicare and Medicaid Services (CMS), Kimble Hospital is making available to the public a copy of its standard charges known as a “Charge Master,” “Charge Description Master” or “CDM”.

Since payment rates for hospital care provided to insured patients are either negotiated with health plans, set by the federal government for Medicare, or set by state governments for Medicaid enrollees, the payments hospitals receive for patient care do not necessarily reflect the prices reflected in the Charge Master.  A patient’s responsibility may vary depending on the payment plans negotiated with insurance companies as well as the patient’s individual and/or family deductibles and co-payments with their insurance plan.  Additionally, uninsured patients are not generally expected to pay the hospital’s standard charges as reflected in the CDM and may be eligible for financial assistance.

The information provided is based on information we have gathered from contracts with managed care commercial insurance plans.  This is not a guarantee of what you will be charged. Your actual charges may differ from the estimated charges for many reasons, including the seriousness of your medical condition, actual time the procedure takes and the services and supplies that you receive. 

The charges listed here are for services from the Hospital.  They do not reflect the charges for physicians (such as surgeon, anesthesiologist, radiologist, pathologist, etc.) who may be involved in providing particular services to a patient. These charges are billed separately from the individual physician/physicians group.

Coleman County Medical Center shall not be liable for any difference between charges listed in the price lists and the final bill for services. 

AVAILABLE FILES 
There are three files regarding the hospital’s CDM for price transparency.  

The CSV file is a comprehensive, machine-readable file that makes public all standard charge information for all hospital items and services.  This can easily be imported into Microsoft Excel or similar software. This file contains the following information:  

Charge Code – specific charge code for each item or service

Description – description of each item or service

Department – department where item or service performed

Rev Code – corresponding department’s revenue code for item or service

CPT Code – corresponding CPT billing code for item or service (if applicable) 

Gross Charge – corresponding gross charge for each individual item or service

Cash Price – corresponding discounted cash price that applies to each item or service

Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header

De-identified minimum negotiated charge that applies to each item or service

De-identified maximum negotiated charge that applies to each item or service 

The first PDF file is a searchable consumer-friendly format of payer-specific negotiated charge information of 300 “shoppable outpatient services” at the hospital.  The file contains the following information:  

Charge Code – specific charge code for each item or service

Description – description of each item or service

Department – department where item or service performed

Rev Code – corresponding department’s revenue code for item or service

CPT Code – corresponding CPT billing code for item or service (if applicable) 

Gross Charge – corresponding gross charge for each individual item or service

Cash Price – corresponding discounted cash price that applies to each item or service

Payer-Specific Negotiated Charge – each column lists the negotiated charge with the name of each specific third-party payer as the column header

De-identified minimum negotiated charge that applies to each item or service

De-identified maximum negotiated charge that applies to each item or service

The second PDF file is a searchable consumer-friendly format of average charge per admission to the hospital.  The file contains the following information:  

MS DRG – Diagnosis Related Group Code – specific DRG for Inpatient admission based on diagnosis

DRG Description – description of admission based on diagnosis criteria

DRG Weight – CMS’ weight assigned to corresponding DRG (diagnosis).  The higher the DRG weight, the higher level of acuity/care the patient needs.  

Average Length of Stay – average length of stay of the patient based on the corresponding DRG code.  Some average length of stay are larger than others due to patients being in the hospital’s Medicare Swing Bed unit.  

Average Charge per Admission – average total charges for a patient with the corresponding DRG code.  

Average Charge per Day – average charge per day incurred for a patient with the corresponding DRG code.  

 

QUESTIONS?

If you have further questions about the Coleman County Medical Center CDM, please contact our hospital business office at (325) 625-2135 or come by and speak to one of our business office representatives.  

Thank you for choosing Coleman County Medical Center for your health care needs!  

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