Effective January 1, 2019, in an effort to “improve the transparency of hospital charges”, the Center for Medicare and Medicaid Services (CMS) has mandated that all facilities participating in the Medicare and Medicaid programs “make public a list of their standard charges” via the internet [CMS1694-F].
The County of Santa Clara Health System gladly supports this effort and is therefore providing this information to our patients by posting our price file for both facility and professional charges for our O’Connor Hospital campus on this site.
The Price File, also known as the Charge Description Master (CDM) consists of two master lists of charges related to all services including professional fees, supplies, devices, vaccines, radiopharmaceuticals, and room accommodation charge codes for inpatients and outpatients of O’Connor Hospital. There are currently two Price Files in use at O’Connor Hospital.
- The Hospital Billing (HB) Price File contains all facility related charges.
- The Professional Billing (PB) Price File contains all of the professional service related charges for providers employed by O’Connor Hospital.
Together, these two Price Files constitute the Charge Description Master (CDM) for O’Connor Hospital.
The Price File contains following elements:
- Procedure Master Number – A unique identifier within the system for each chargeable item.
- Procedure Record Name – A brief description of the service.
- CPT© (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) code - This is a nationally recognized alphanumeric code utilized by the insurance industry and government payors to identify a particular service or item.
- Unit Charge – The gross dollar amount charged for each item to the account.
Variable prices may be present for services such as Reference Lab testing, implanted devices and items/services governed by other contracted rates. These prices may not be available for listing in the CDM since billed charges are based upon the charges invoiced by the contractor to O’Connor Hospital at the time the service is provided.
Pharmaceutical prices listed are acquisition cost based. These costs may vary depending upon many factors such as date purchased and supplier. The patient may, therefore, see multiple prices for what appears to be the same medication. In practice, depending upon the dosage ordered by the provider, a patient may see multiple units of a single medication listed on a claim. The total of these units represents the total dosage provided to the patient. Due to these variances, we recommend that our patients contact the O’Connor Hospital Pharmacy department directly for the most accurate estimate based upon the providers medication orders.
Diagnostic Laboratory Testing
In accordance with the Families First Coronavirus Response
Act (FFRCA), the Coronavirus Aid Relief and Economic Security Act (the CARES
Act) and other healthcare pricing transparency regulations, related to
Coronavirus 2019 (COVID-19), the County of Santa Clara Health System is
providing this list of laboratory testing service prices. The test performed
will depend upon the test ordered by your physician.
Please note that items appended with an “*” and number are
tests performed by an outside reference lab. These prices are set by the
outside laboratory and are charged as a “pass through” charge at no additional cost
to the patient or payor.
COVID-19 Tests Price File
TOP 50 DRGS
For your information, we have also provided a list of average total charges for our Top 25 DRGs (Diagnosis Related Groups)
O'Connor Hospital Top 50 DRGs List File
Individual departments within O’Connor Hospital may generate charges through an electronic charge or order communication system. Most charging information for a patient admission or encounter originates from the CDM. The charges, charge descriptions, and all codes attached to a line item in the CDM, flow through electronic systems to Patient Business Services (PBS), where corresponding claims are generated. The claims may be edited before submission to the appropriate payors based upon contractual terms.
The total charges listed for a particular encounter or admission may not necessarily represent the total payment expected by O’Connor Hospital. The expected payment amount will vary based upon contractual arrangements between O’Connor Hospital and the various payors, the insurance plan in which the patient is enrolled and other special programs for which the patient may apply and be found eligible for.
In addition, it is possible that patients may receive additional statements of charges for services provided from their private physicians or other consultative physicians who may not be under contract with O’Connor Hospital or The County of Santa Clara Health System.
Should a patient require financial assistance or advice, they are encouraged to contact a Financial Counselor at (866) 967-4677
VISIT AND PROCEDURE ESTIMATE
Should a patient wish to obtain an estimate of charges for a visit or procedure, they are encouraged to contact the Revenue Integrity Unit at (408) 885-6884 or via email at HHSCDM@hhs.sccgov.org for assistance.
CPT© Codes 2019 American Medical Association, use of this site denotes acceptance of below terms and conditions
CPT© codes, descriptions, and material only are copyright 2019 American Medical Association (AMA). All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT© . AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. CPT© is a trademark of the American Medical Association.
Current Dental Terminology copyright © 2018 American Dental Association. All rights reserved.