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Standard Charge File and Guest Estimates

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, St. Louise Regional Hospital (SLRH) 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 (CSCHS) 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 SLRH 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 SLRH:

  1. Total charges for services provided at SLRH
  2. Discounted cash (self-pay) prices
  3. De-identified minimum and maximum negotiated rates
  4. Payer-specific negotiated rates

STANDARD CHARGE FILE

St. Louise Regional Hospital Standard Charge File

GUEST ESTIMATES

St. Louise Regional Hospital Guest Estimator link

This tool provides an estimate of potential charges ONLY, based upon the information the user 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 St. Louise Regional Hospital (SLRH) 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. SLRH 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 Estimator Tool, for a procedure or encounter, may not necessarily represent the total payment expected by SLRH. The expected payment amount may vary based upon updated contractual arrangements between SLRH and the various payors, the insurance plans in which the guest is enrolled, and other special programs for which the guest may apply and be found eligible for.

The estimate provided by the Estimator Tool does not constitute a contract and does not obligate our guest(s) to receive the items or services from SLRH or any other provider.

Please note: The estimate of potential charges generated by the Estimator Tool is not the same as the Good Faith Estimate required under the No Surprises Act.  For more information about the Good Faith Estimate required under the No Surprises Act, please visit our “No Surprises Act” page.


FINANCIAL ASSISTANCE

Should a guest have questions regarding their bill or require financial assistance or advice, they are encouraged to contact a Financial Counselor at (866) 967-4677 for direction.


PRICE FILE

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 St. Louise Regional Hospital (SLRH). There are currently two Price Files in use at SLRH. 

  1. The Hospital Billing (HB) Price File contains the facility related charges.
  2. The Professional Billing (PB) Price File contains the professional service-related charges.

Together, these two Price Files constitute the Charge Description Master (CDM) at St. Louise Regional 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 as invoiced by the contractor to SLRH 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 SLRH Pharmacy department directly for the most accurate estimate based upon the providers medication orders.

Pricing in the SLRH Price File is updated on July 1st of each year. Prices listed will correspond with prices as established by resolution of the Board of Supervisors of the County of Santa Clara for the current fiscal year. SLRH reserves the right to modify these charges in accordance with organizational policies.


TOP 50 DRGS

For your information, we have also provided a list of average total charges for our Top 50 DRGs (Diagnosis Related Groups).

St. Louise Regional Hospital Top 50 DRGs


CHARGE GENERATION

Individual departments within St. Louise Regional Hospital (SLRH) 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 SLRH. The expected payment amount will vary based upon contractual arrangements between SLRH 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.


CPT© Codes 2021 American Medical Association, use of this site denotes acceptance of below terms and conditions

CPT© codes, descriptions, and material only are copyright 2021 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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