Pricing Transparency Frequently Asked Questions (FAQ)
What is pricing transparency?
Nevada Regional Medical Center understands that informed healthcare decisions include cost information. "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 responsibility.
For an individual estimate please contact our admissions team at 417-667-3355.
What is Charge Master Description (CDM)?
Charge Master Description or “Chargemaster” is a term used to describe a list of all standard charges billed by the provider. Nevada Regional Medical Center (NRMC) 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 NRMC’s actual reimbursement from all patients or insurance companies. NRMC’s reimbursement can change depending on a variety of internal and external factors, including negotiated rates with a 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 NRMC’s CDM are updated annually on or shortly after our fiscal year, July 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 NRMC’s published CDM will include charge description and charge.
If you are comparing NRMC’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 cost please call 417-667-3355 and ask to speak to a financial counselor.
What is a 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.
NRMC has listed our CDM.
To understand your estimated out-of-pocket costs please call 417-667-3355.
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 databases 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), radiologists, 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 NRMC for an estimate?
The best place to start would be with our financial counselors. They will be able to check into pricing and call you back with an estimate. 417-667-3355
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 performing: name and phone number.
- Name of the insurance company if insured, including:
- Policy number
- Group number
- Name of insured or subscriber
Can I get an exact quote?
NRMC 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 NRMC. 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.
NRMC offers a self-pay discount for our patients with no health care insurance automatically and prior to billing. NRMC also offers financial assistance to those who qualify. To find out more about NRMC financial assistance or apply please see financial assistance found on the NRMC website.