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Hospital Pricing Transparency

As the community-owned healthcare system for the nation's third most populous county, Harris Health delivers fully integrated healthcare services to a broad cross section of Harris County residents. Some of our patients are funded by Medicare, Medicaid or private insurance, but many are among the roughly 1 million Harris County residents who are uninsured or underinsured.

During fiscal year 2020, Harris Health provided $720 million of charity care, delivering a level of quality that rivals top-notch private institutions. In fact, Harris Health System boasts numerous clinical services that are among the best in the nation and two hospitals that are Magnet-recognized for nursing quality and safety and excellent patient outcomes.

 

Charge Description Master

The Charge Description Master (CDM) or charge master is a comprehensive database of all billable/non-billable items that can be billed to patients’ accounts. It contains the descriptions, billing codes (i.e., revenue codes and CPT®/HCPCS codes), and charge amounts for these services. These charge amounts rarely reflect the amount a patient owes at the time of billing.

Many things — including the patient’s health insurance plan/benefits, and the amount of monies the patient both owes and has paid toward their yearly deductible, coinsurance and out-of-pocket maximum — determine the amount the patient will be billed for services provided. For example, Harris Health’s indigent patients’ financial responsibility is determined by their eligibility application. Another example is Medicare/Medicaid patients whose financial responsibilities are determined by the state and federal rules associated with their benefits that are communicated back to the provider/facility when Medicare/Medicaid pays their portion of the claim. If there is a patient amount due, the patient will be billed the amount Medicare/Medicaid identifies as patient responsibility. Another example is commercial insurance patients whose benefits and financial responsibility (for both in-network and out-of-network providers/facilities) are defined in their health insurance plan's coverage documents. These patients will be billed the amount the payor identifies as patient responsibility when the health insurance plan pays their responsible portion of the claim. A final example is for self-pay patients who do not have formal health insurance plan benefits or state or federal rules geared toward determining their financial responsibility; Harris Health System has adopted a process where Medicare’s benefits and fee schedules are used to determine the self-pay patients’ financial responsibility or billed amount. This means that self-pay patients are expected to pay, not the actual charge amount, but rather the amount Medicare would have paid based on their fee schedules. If the service is not a benefit of Medicare but is a benefit of Medicaid, a Medicaid fee schedule will be utilized.

 

Shoppable Service
A shoppable service is a service that can be scheduled by a healthcare consumer in advance.

Such services 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.

Examples of common shoppable services include imaging and laboratory services, medical and surgical procedures, and outpatient clinic visits.

 

You may download the following ZIP files for review:

Charge Description Master
This document includes:

  • Description of the service
  • CPT/HCPCS code of the service
  • Charge Amount
  • Medicare/Medicaid fee schedule (the amount the self-pay patient would owe)

 

Pharmacy
This document includes:

  • Description of the service
  • CPT/HCPCS code of the service
  • Charge Amount
  • Medicare/Medicaid fee schedule (the amount the self-pay patient would owe)

 

Supplies
This document includes:

  • Description of the service
  • CPT/HCPCS code of the service
  • Charge Amount
  • Medicare/Medicaid fee schedule (the amount the self-pay patient would owe)

 

Diagnosis-related Group (DRG) Table
This document includes:

  • DRG (for inpatient services)
  • Medicare Reimbursement (the amount the self-pay patient would owe)

 

COVID-19 Diagnostic Test(s)
This document includes:

  • Description of the service
  • CPT/HCPCS code of the service
  • Charge Amount
  • Medicare/Medicaid fee schedule (the amount the self-pay patient would owe)

 

Shoppable Services
This detail includes:

  • Description of the service
  • CPT/HCPCS code of the service
  • Revenue code
  • Location
  • Charge amount
  • Self-pay (the amount the self-pay patient would owe)
  • Contracted payors:
    • Texas Medicaid
    • Molina Healthcare Star/Star Plus – Based on 100% of Texas Medicaid
    • Molina Healthcare CHIP Based – Based on 100% of Texas Medicaid
    • Superior Health Plan Star – Based on 100% of Texas Medicaid
    • Texas Children’s Health Plan Star – Based on 100%
    • Texas Children’s CHIP – Based on 100% of of Texas Medicaid
    • Community Health Choice Star – Based on 102% of Texas Medicaid
    • Community Health Choice CHIP – Based on 102% of Texas Medicaid
    • Amerigroup Star/Star Plus – Based on 101% of Texas Medicaid
    • Amerigroup CHIP – Based on 101% of Texas Medicaid
    • United Healthcare Star/Star Plus – Based on 100% of Texas Medicaid
    • United Healthcare CHIP – Based on 100% of Texas Medicaid
    • Medicare
    • Superior Medicare – Based on 100% of Medicare
    • Amerivantage – Based on 102% of Medicare
    • Amerigroup MMP – Based on 102% of Medicare
    • Molina Medicare – Based on 105% of Medicare
    • United Healthcare Medicare – Based on 100% of Medicare
    • United Healthcare MMP – Based on 100% of Medicare
    • BCBS Medicare – Based on 100% of Medicare
    • Aetna Commercial HMO * +
    • Aetna Commercial PPO * +
    • Community Health Choice Marketplace – Based on a percentage of Medicare
    • Molina Marketplace – Based on Medicare methodology
    • United Healthcare Commercial 
    • BCBS HMO *
    • BCBS PPO *
    • Cigna Commercial *
    • Optum Behavioral Health *
  • Minimum contractual reimbursement
  • Maximum contractual reimbursement
  • No amount provided under charge amount denotes services not provided (charged or billed) at Harris Health System
  • The requirement for the file was for CMS MS-DRG’s, ones accepted by Medicare and other commercial payors. Harris Health System has added to the file the Texas Medicaid APR-DRG’s in order to provide an estimate for Medicaid related payments/services. Where Texas Medicaid rates are unusually low that generally represents services that are not applicable or low volume
  • Hospital pass through rates, add on rates, and standard rate reductions by CMS and Texas Medicaid are not reflected in these files.

* Denotes contracts with less than 1% utilization.
+ Denotes contracts paid by a daily rate (per diem).

 

Harris Health System also has available a hardcopy of its charge description master for public viewing Monday through Friday, 8 a.m. - 4 p.m. (excluding holidays). To view a copy the charge description master, please visit:

Patient Financial Services
Harris Health System
4828 Loop Central Drive, Suite 300
Houston, Texas 77081

If you have questions, please call 713-566-6600 or email customerservice@harrishealth.org.