SHOPPABLE SERVICES/ESTIMATE OF POTENTIAL CHARGES
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]. Further, O’Connor Hospital is happy to provide our Guest Estimate function in order to provide for our patients the ability to calculate an estimate of potential charges and patient liability for the most common 300 shoppable services as required by CMS and the President’s Executive Order.
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.
In addition, in compliance with CMS Outpatient Prospective Payment System Policy [CMS-1717-F2, Doc Citation 84 FR 65524], we have provided a machine-readable file which includes the following information regarding services provided at O’Connor Hospital:
- Gross charges
- Discounted cash (self-pay) prices
- De-identified minimum negotiated charges
- De-identified minimum and maximum charges
- Payer-specific negotiated charges
STANDARD CHARGE FILES
O’Connor Hospital Guest Estimator link
This is tool provides an estimate of potential charges ONLY, based upon the information our guest has provided, on the date that the estimate was created. It is not intended as a comprehensive list of charges or a final liability or payment agreement between O’Connor Hospital and the account guarantor.
When services are provided there may be additional charges for supplies, medications and other clinical services as ordered by the guest’s physician. OCH reserves the right to modify these charges in accordance with organizational policies. This estimate does not represent a guarantee of these prices for services on the date services are rendered.
The total charges listed by the Guest Estimator, for a procedure or encounter, may not necessarily represent the total payment expected by O’Connor Hospital. The expected payment amount may vary based upon updated contractual arrangements between O’Connor Hospital and the various payors, the insurance plans in which the patient is enrolled and other special programs for which the guest may apply and be found eligible for.
If our guests are unable to calculate the estimate using this tool, they are encouraged to contact the Revenue Integrity Department at (408) 885-6884 or via email at [email protected] for assistance.
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.
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.
COVID-19 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.
Should a patient require financial assistance or advice, they are encouraged to contact a Financial Counselor at (866) 967-4677 for direction.
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 [email protected] 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.
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