Transparency in Healthcare

CMS Pricing Transparency

CMS finalized new hospital price transparency requirements under section 2718(e) of the Public Health Service Act, as well as a regulatory plan under section 2718(b)(3) that enables CMS to enforce those requirements, in the Calendar Year 2020 Outpatient Prospective Payment System (OPPS) Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates: Price Transparency Requirements for Hospitals to Make Standard Charges Public (CMS-1717-F2) final rule (Hospital Price Transparency final rule). The Hospital Price Transparency final rule was published in the Federal Register on November 27, 2019 (84 FR 65524) and is available here and in compliance with federal and state law, Encompass Health provides price transparency and patient billing information to all patients.

Actual charges will vary based on medical need at the time services are rendered. Please contact the Hospital directly at the phone number listed above if you have any questions about our standard charges or to obtain a prospective service quote. Fees for physician services are not reflected in our standard charge list and will be billed separately by your physician.

Requesting an Estimate

Patients may request an estimate of anticipated charges. Estimates will be provided within 7 business days from the receipt of request. Estimates will be based on average historical charges for the anticipated services to be provided however, you may request a more personalized estimate. Patients are encouraged to contact their health plan for information regarding anticipated cost sharing responsibilities.

To request an estimate, please contact the hospital’s Controller by calling the hospital at the hospital phone number listed above.

Please note the following:

• Actual costs may exceed the estimate.
• Physician services may be billed separately. These physicians may or may not participate with the same health insurers or health maintenance organizations (HMOs) as Encompass Health Rehabilitation Hospital. You should contact the health care practitioner who will provide services to you to determine which health insurers and HMOs the practitioner participates in as a network provider or preferred provider, as well as request a personalized estimate of reasonably anticipated charges for the treatment of your specific condition.
• You may pay less for services at another facility or in another health care setting.

Health plans can be very different and we encourage you to contact your health insurance provider directly if you have questions about your deductible, copayment, coinsurance and benefit limits. If you are not covered by health insurance, we encourage you to contact the hospital at the hospital number listed above to determine if you qualify for discounts and discuss payment options prior to receiving health care services from our inpatient rehabilitation facility.

Before we bill you, we will bill your insurance provider, including Medicare and Medicaid if applicable, and any additional insurance providers. We do not charge interest on any balance due after insurance payments are received.

If you are unable to pay the amount you owe in full, you may contact the hospital at the hospital number listed above to arrange for payment plans or to learn more about financial assistance options available. Financial assistance information is also available on the hospital’s website.

Note: Section 2718(e) of the Public Health Service Act, as enacted by the Affordable Care Act, requires “each hospital operating within the United States” to “make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups (DRGs) established under section 1886(d)(4) of the Social Security Act.”

Section 4421 of the Balanced Budget Act (BBA) of 1997 (Public Law 105-33), as amended by section 125 of the Balanced Budget Refinement Act (BBRA) of 1999, authorized the implementation of a per discharge prospective payment system (PPS), through section 1886(j) of the Social Security Act, for inpatient rehabilitation hospitals (IRFs). Section 1886(j)(2)(A) provides that Medicare will pay for treatment in an IRF by dividing patients into case-mix groups, CMGs, that are predictive of the resources needed to furnish patient care to various types of patients.

Latest Payer-Specific Negotiated Charges

Managed care payers / plans pay inpatient rehabilitation hospitals based on an overall rehabilitation service category or program, also referred to as a “service package” by CMS.  A service package payment would apply when the managed care plan pays the hospital on a per day basis (per diem) or on a case specific basis (per discharge) or as a flat rate. For these three payment types, specific procedures and tests, etc. are not paid individually.  All the relevant services are grouped together and paid as a service package.  If the managed care plan pays the hospital according to a discount off of total billed charges, then the discount is applied to every line on the claim in order to calculate the total payment made to the hospital.  The billing code(s) used to determine payment for service packages (per diem and per discharge and flat rate contracts) are most commonly the Room and Board (R&B) revenue codes.  Room and Board revenue codes include revenue codes 118; 120; 128; 138; 148 and 158.  Other Revenue Codes will appear on the billing claim but they do not impact the payment.  Individual billing codes for all the services listed on a claim would be used to determine payment for contracts paid on a discount off of billed charges.

On average a patient will stay 14 days in an inpatient rehabilitation hospital this varies by each patient.  Therefore, if the managed care plan pays on a per day basis you would need to multiply the per day amount by 14 to get an estimate of the total payment.  The typical inpatient rehabilitation service category or program (service package) will include:

• Room and Board Services (private or semi-private room)
• All related therapy services (i.e. physical; occupational; speech, etc.)
• Routine supplies
• Routine medications
• All nursing services

Please note that physician services are not included and are billed separately by each individual physician and paid separately by the managed care plans.  The information provided here does not include any physician services.

On a less frequent basis other services may be required and may be paid in addition to the services listed above.  These services may be billed by a different provider.  Examples of these additional services may include but are not limited to

• Special equipment
• High cost pharmacy items
• Dialysis treatments
• High cost diagnostic services such as a CT Scan or MRI

If “NA” is listed under the plan you are researching you will need to scroll down the column to find the relevant pricing category for that particular plan.  If you do not see a specific plan listed, our hospital may not have a contract with that particular plan. If you have any questions please call us at 505.344.9478 and ask to speak with an admissions representative and we will provide you with the most current information available.

Download our listing of Payer Specific Negotiated Charges below (csv):

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Latest Shoppable Services

The Centers for Medicare Services (CMS) has defined a “shoppable service” as a service package that can be scheduled by a health care consumer in advance. Shoppable services are typically those that are routinely provided in non-urgent situations that do not require immediate action or attention to the patient, thus allowing patients to price shop and schedule a service at a time that is convenient for them.

The Centers for Medicare and Medicaid Services (CMS) published a listing of 70 Shoppable Services listed with their primary billing code(s) which are required for hospitals to display their negotiated charges by each managed care plan. If a particular service is not offered by our hospital, a “NA” will be displayed. The required services are included below in the Shoppable Services file. In addition to the 70 required services, hospitals are required to list 230 additional shoppable services for a total of 300 shoppable services. We have listed the most common services or service packages we provide with the corresponding negotiated charges paid by the managed care plans in the Shoppable Services file.

If you have any questions regarding the information provided please call 505.344.9478 and ask to speak with an admissions representative.

Download our listing of Shoppable Services below (csv):

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