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.