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How Chargemaster Data May Affect Hospital Revenue

Cheryl Clark, for HealthLeaders Media, May 21, 2013

They too might see a big difference in what they might have to pay by looking at the charge master and comparing regional costs.

For example, one Blue Cross Blue Shield of Massachusetts Medicare Advantage Plan would require such enrollees to pay "20% of the cost for each inpatient hospitalization stay" for care in an out-of-network hospital, which it would be if the hospital is outside Massachusetts, according to a BCBS-MA brochure.

Whether the "cost" the brochure mentions is the sticker price, called the "average covered charge," or the much lower "average total payment" Medicare pays, is unclear. But they'd surely owe a lot more money than the $150 per day charge listed for those enrollees treated in an in-network Massachusetts hospital.

Joseph Fifer, President and CEO of the Healthcare Financial Management Association, says he thinks hospitals should publish all of their charges for all of their DRGs on their webpages. And that will happen, he thinks, but it will take some time.

Until now, he says, "hospitals didn't know what other hospitals were charging. The restraint of trade lawyers would put the fear of God into their chief financial officers saying, we can't find out what the pricing is at other hospitals for fear of (being accused of) anti-trust behavior."

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