As of January 1, 2019, the Centers for Medicare and Medicaid Services (CMS) requires all hospitals nationwide to establish, update and make available on the internet a list of their Standard Hospital Charges/Diagnosis Related Group (DRG) Charges. This list captures most items and services provided to patients. The new regulations require the list to be available in a machine-readable format that can be accessed by patients and automatically read and processed by a computer.
As every insurer pays hospitals differently, the list of charges does not represent the true costs of care for patients - in fact, the costs are usually significantly less – and it is not a useful tool for patients who are evaluating costs of care. While CMS’ intent is to increase price transparency, this new regulation may create confusion for patients. Clinicians and front-line staff may receive questions from patients about the charge lists and their accuracy.
Partners is working with all hospitals to ensure they comply with this regulation but also to ensure that patients have the appropriate channels to get accurate information about their health care costs. Most Partners hospitals will link to the Billing and Financial Assistance section on Partners.org. If a patient goes to the Partners site, they will be re-directed to the best way to request a cost estimate, which is to contact Patient Billing Solutions at 617-726-3884.
For help responding to patients with questions, please review the Questions and Answers document. For questions about what this means to you, please contact Lynda Brown, Partners Director of Revenue Integrity at email@example.com.
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