As the community-owned healthcare system for the nation's third most populous county, we deliver 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 2018, Harris Health provided $651 million of charity care, delivering a level of quality that rivals top-notch private institutions. In fact, Harris Health System boasts numerous centers of excellence that are among the best in the nation.
Charge Description MasterThe Charge Description Master (CDM) or charge master is a database of all billable/non-billable items that go on 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 Plan 1 or Plan 2 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.
Charge Description MasterThis 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)
PharmacyThis 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)
SuppliesThis 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)
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 ServicesHarris Health System4828 Loop Central Drive, Suite 300Houston, Texas 77081
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