What is pricing transparency?
Price transparency is a term used in healthcare and by Centers for Medicare and Medicaid (CMS) as a rule that requires hospitals to provide prices for standard charges that are in the hospitals charge description master (CDM). This rule requires hospitals to make prices available to their consumers so they can make more informed healthcare decisions. The information found on our published CDM should not be used to accurately estimate or determine your out of pocket patient responsibilities. For an individual estimate please contact our admissions team at 417.347.3543 or by emailing: _ADMPRECERT@freemanhealth.com. Freeman Health System (Freeman) understands that quality of healthcare includes decisions on healthcare cost. To assist consumers in managing their financial health, we offer free and individualized estimates based on your health insurance and benefits.
What is Charge Description Master (CDM)?
Charge Description Master or “Chargemaster” is a term used to describe a list of all standard charges billed by provider. Freeman Health System (Freeman) has a standard CDM and charges the same for all patients, regardless of insurance company or coverage. However charges contained in CDM may not reflect Freeman’s actual reimbursement from all patients or insurance companies. Freeman’s reimbursement can change depending on a variety of internal and external factors, including negotiated rates with health plan, fixed government rates, individually packaged rates, and self pay discounts. Other factors that can change reimbursement and cost could include whether care is provided in an Inpatient setting, Outpatient setting or Observation setting. Complications and comorbidities, medical necessity and specialty services or services deemed as experimental by a payer, can also affect cost and or reimbursement.
Charges published in Freeman’s CDM are updated annually on or shortly after our fiscal year, April 1st. Individual charges may change more frequently due to new technology, added or eliminated services, and changes made by manufacturer or vendors.
Each service found in Freeman’s published CDM will include: charge description and charge.
If you are comparing Freeman’s CDM to other hospitals CDMs it is important to note that descriptions and charges contained in each CDM may vary from hospital to hospital. To understand your estimated out of pocket costs please call 417.347.3543 or email for an estimate at: _ADMPRECERT@freemanhealth.com.
What is Diagnosis Related Group: (DRG)?
This is a term that identifies and groups services and procedures into a reimbursement amount for the grouped DRG. This is an Inpatient only reimbursement method, and not all payers use this method of reimbursement. Each grouped set has a fixed fee regardless of the actual charges. Freeman has listed both our CDM and our charges by DRG. Please find a link on our web page, to view charges by DRG. The amount listed is an average for DRG, based on resources this amount can vary either higher or lower. To understand your estimated out of pocket costs please call 417.347.3543 or email for an estimate at: ADM Precert/Price Quote.
FAQ’s for CDM:
What is Charge Description Master (CDM) or Chargemaster?
A CDM or Chargemaster is a facility specific comprehensive listing of all standard charge items that can be billed by the hospital to a payer, patient or facility. The CDM is very technical and detailed with itemized descriptions developed to meet government and health plan guidelines.
Are all charges listed in CDM?
Almost all billable charges are found in CDM, however there are some additional data bases that exist outside of the CDM such as; physician professional charges, complex or compound pharmaceuticals, pathology, custom items or new technology. Charges for care provided by independent providers of service such as lab specialty test(s), ER physicians, or on-call specialty physicians may not be found in our CDM.
How should I use CDM for “cost comparison”?
A hospital or provider CDM is not a useful document for consumers or patients who are “comparison shopping” or attempting to get an accurate out of pocket patient responsibility because descriptions for particular services could vary from hospital to hospital. Procedure charges may be found in more than one department and some hospitals may bundle or package charges into one or more charges based on their charge practices. Please note that pharmacy charges found in CDM are hospital dispensed charges are not the same as retail pharmacy charges.
Who should I contact at Freeman for an estimate?
At Freeman we have arranged two methods to submit a request for a price quote.
- By Phone: contact our Admissions quote phone number at 417.347.3543.
- Send email to: _ADMPrecert@freemanhealth.com.
What do I need to provide for an estimate of out of pocket or patient responsibility?
- Description of services (CPT and diagnosis code or ICD10).
- Type of service needed (Inpatient, Outpatient or Observation).
- Physician/Specialist ordering or preforming: name and phone number.
- Name of insurance company if insured.
- Policy number
- Group number
- Name of insured or subscriber
Can I get an exact quote?
Freeman will do our best to provide an individualized quote based on your health plan, benefits, and out of pocket amounts owed and reported by your health plan, and historical pricing for comparable services provided by Freeman. Estimates are not a guarantee since services used to calculate the estimate can vary from; services you receive that differ due to treatment decisions, unforeseen complications, additional tests and services ordered by your physician and health needs for each patient.
Freeman offers a self-pay discount for our patients with no health care insurance automatically and prior to billing. Freeman also offers financial assistance for those who qualify. To find out more about Freeman financial assistance or apply please see financial assistance found on Freeman website.
Disclaimers
The out of pocket cost estimate information is not a guarantee of final patient responsibility. Estimates are based on information provided by you and/or your physician and your insurance company. Timeliness of claims processing may affect your overall out of pocket estimate. Professional fees such as (physician, pathology or specialist) may not be included in estimates as some of these services may be billed separately.
All estimates are based on estimate of provided service, and any and all health plan requirements such as: pre-authorization, pre-certification, referrals etc., prior to service. Patients are responsible for knowing if their individual health plan is “in-network” or “out-of-network” and if services are deemed experimental, investigational or medically necessary by individual’s health plan.
Freeman is not responsible for the content read by your device viewing Freeman Health System’s data found on the internet. Please consider security of any data saved, or viewed from public websites.
Definitions
Charge: Dollar amount assessed to chargeable item.
Allowed Amount: Amount approved by health plan and agreed upon by provider that includes insurance portion and patient responsibility.
Co-insurance: Amount determined and set by health insurance to be paid by patient or responsible person(s) applied to covered benefits. This is usually a percentage of allowable. Example: patient is seen for lab work in hospital and insurance allows $100.00, and applies 20% of allowable to patient responsibility. The insurance would pay the hospital $80.00 and patient or responsible party would be responsible for $20.00.
Deductible: Amount determined annually and set by health insurance to be paid before insurance pays on benefits. There is often an individual deductible as well as family deductible. Insurance companies may assign an in-network deductible and or out of network deductible as well. Example: patient is seen at Urgent care, insurance allows $150.00 for treatment provided. If patient has not meet deductible the patient would owe $150.00 which would be applied to deductible. If total deductible was $200.00, patient would still owe $50.00 before insurance started to pay on covered benefits.
Inpatient: A patient status assigned by treating physician. Inpatient criteria and level of care must meet medical necessity for Inpatient stay. A patient does not always need to stay overnight to meet inpatient level of care.
Outpatient: Care provided in an outpatient setting where care is delivered such as lab or xray and once tests are completed patient goes home.
Observation: A patient status assigned by treating physician. Observation can occur anywhere in the hospital, where bed is available and patient is monitored by nurses and physician. Observation is considered an outpatient benefit and coverage for outpatient care must be available from payer.
Outpatient in a bed: A patient status that is considered an outpatient level of care, where a patient is cared for and monitored for either discharge home or changed to a higher level of care such as Observation or Inpatient care.
In-Network: Provider of care is contracted with payer. Please note that the patient or responsible party is responsible for knowing if the provider they are seeking care from is in network. Having care provided by an In-network provider often reduces patient out of pocket.
Out of Network: Provider of care is not contracted with payer. Please note that the patient or responsible party is responsible for knowing if the provider they are seeking care from is in network. Having care provided by an out-of- network provider often increases patient out of pocket.
Physician Professional Charges: Are charges for the professional or doctor’s time and resources.
Copay: is set amount determined by health insurance for specific services such as doctor office copay. Example: patient is seen at doctor’s office, insurance assigns a $25.00 copay for doctor’s office, and then allowed amount is paid by health insurance. This amount is often required prior to seeing doctor and collected upon presenting for services.