Short Term Acute Care HospitalVoluntary Non-Profit - Private
Capital Region Medical Center
University of Missouri Health Care · Jefferson City, MO
1125 Madison Street, Jefferson City, MO 65101(573) 632-5000
114
Beds
2,426
Inpatient discharges a year
$116.1M
Net patient revenue a year
24
In-network payers
About this hospital
Capital Region Medical Center is a 114-bed voluntary non-profit - private hospital in Jefferson City, MO, affiliated with University of Missouri Health Care. Below you'll find publicly disclosed negotiated rates and facility details, including 24 in-network payers and 422 disclosed rate categories.
Jurisdiction 5, WPS Government Health Administrators (05901)
Prices for common services
The 24 services Capital Region Medical Center most likely performs, ranked by likely volume and what it is paid. Each service names one insurer. * marks hidden insurer names; A, B and C rank the remaining rates from low to high and reset for each service.
CMS lists this service as CPT 59400, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
Childbirth · Inpatient
Cesarean delivery, hospital stay
MS-DRG 788
$4,810 - $24,210
from 4 insurers · median $9,407
Cigna$24,210
Insurer A*$4,810
Insurer B*$7,057
Insurer C*$11,758
CMS lists this service as CPT 59510, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 788, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
Medicine & Surgery · Inpatient
Major lower-extremity joint replacement without MCC
MS-DRG 470
$11,089 - $49,187
from 4 insurers · median $19,466
Aetna$15,171
Insurer A*$11,089
Insurer B*$23,761
Insurer C*$49,187
Medicare $12,808Nearby hospitals $19,287In line with nearby hospitals
38 Medicare discharges for this DRG in CMS hospital data
Medicine & Surgery · Inpatient
Major cardiothoracic procedure with cardiac catheterization and MCC
Hospital reports cardiac thoracic surgery services to CMS
Childbirth · Inpatient
Vaginal birth after prior cesarean, hospital stay
MS-DRG 807
$3,489 - $17,192
from 4 insurers · median $6,000
Cigna$17,192
Insurer A*$3,489
Insurer B*$4,962
Insurer C*$7,038
CMS lists this service as CPT 59610, the obstetrician's global fee. The hospital bills the delivery stay as MS-DRG 807, so these are facility case rates.
Hospital reports obstetrics / child birth services to CMS
Medicine & Surgery · Inpatient
Uterine and adnexa procedure for non-malignancy without CC or MCC
MS-DRG 743
$6,789 - $31,018
from 4 insurers · median $11,771
Aetna$8,874
Insurer A*$6,789
Insurer B*$14,668
Insurer C*$31,018
Medicare $8,362Nearby hospitals $12,224In line with nearby hospitals
Hospital reports inpatient surgical services to CMS
How the insurers pay at Capital Region Medical Center
Median rate as a percent of Medicare across the outpatient services above, and how many services sit above or below the same insurer's median at nearby hospitals. * marks hidden insurer names. These table labels track the same insurers across services; the labels on each service card reset.
Insurer
Services
Median % of Medicare
Above nearby
Below nearby
Insurer A*
24
209%
18
3
Insurer B*
18
186%
5
9
Insurer C*
22
83%
7
11
Insurer D*
7
48%
3
1
How we chose these services: 1 appear in this hospital's own Medicare claims, 0 are common here based on CMS Medicare volume, and 23 are typical for the service lines it reports to CMS. Rates come from insurer and hospital price transparency files as of October 2026. Rates under a quarter of Medicare or over 20 times Medicare are left out as likely physician-fee rows or file errors. Book a demo to see all 300 CMS shoppable services for Capital Region Medical Center, or start a free trial.
Insurance Accepted
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.
Aspirus Health PlanBanner HealthEMI HealthGroup Health Cooperative of South Central WisconsinHarvard Pilgrim Health Care (Point32Health)Health Alliance
The employer identification numbers (EINs) health plans and networks list for Capital Region Medical Center in the in-network rate files they publish, with the organization NPIs billed under each.
Tax ID (EIN)
Plans and networks listing it
Organization NPIs
44-0546366Capital Region Medical Center
40Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Ambetter and 35 more
1174597892 Curators Of The University Of Missouri1477980837 Capital Region Medical Center1700043791 Capital Region Medical Centerand 36 more
43-6003859(multi-state) Curators of the University of Missouri
24Aetna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Aspirus Health Plan, Avera Health Plans and 19 more
1679664718 Curators Of The University Of Missouri1699769901 Curators Of The University Of Missouri1639291263 Curators Of The University Of Missouriand 51 more
Source: PayerPrice analysis of insurers' Transparency in Coverage in-network files. An EIN can cover several hospitals and clinics in a health system, and insurers sometimes list other organizations' NPIs under it.
Clinical LaboratoryObstetrics / Child BirthPediatric Care
Behavioral health
Adult Inpatient Psychiatric CareAlcohol and/or Drug Service
Rehabilitation and therapy
OT (Occupational Therapy)PT (Physical Therapy)Respiratory CareSpeech Pathology
Other services
Dental CareDietary CareOutpatientPharmacySocial Care
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
Size and patient volume
What Capital Region Medical Center reported to Medicare in its latest cost report, covering Jul 1, 2023 to Dec 31, 2023.
2,426
Inpatient discharges
Medicare 27%, Medicaid 5%
8,371
Inpatient days
45% of available bed days used
611
Employees (full-time equivalent)
5
Interns and residents (full-time equivalent)
Source: CMS cost report (HCRIS) (report 841966). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Utilization by payer and unit
Inpatient days and discharges Capital Region Medical Center reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
Medicare
Medicaid
Other
Total
Inpatient days
2,356
355
5,660
8,371
Discharges
667
118
1,641
2,426
Average length of stay
3.5 days
3.0 days
3.4 days
3.5 days
Average daily census
12.8
1.9
30.8
45.5
2,992
Medicare Advantage days
723 discharges
785
Medicaid managed care days
398 discharges
1,072
Observation bed days
Beds and days by unit
Unit
Beds
Inpatient days
Medicare days
Occupancy
Adults & pediatrics
88
7,140
2,154
44%
Intensive care unit
12
687
202
31%
Nursery
544
Subprovider - irf
14
1,327
648
52%
Source: CMS cost report (HCRIS, Form 2552-10), report 841966, settled without audit. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
Income statement
Revenue, expenses and income Capital Region Medical Center reported to Medicare for Jul 1, 2023 to Dec 31, 2023. Percentages are of net patient revenue.
Line
Amount
Share
Gross patient revenue (charges)
$410.6M
353.8%
Inpatient
$81.3M
70.1%
Outpatient
$329.3M
283.7%
Contractual allowances and discounts
-$294.6M
-253.8%
Net patient revenue
$116.1M
100.0%
Operating expenses
-$135.9M
-117.1%
Operating income from patient care
-$19.8M
-17.1%
Other income
$10M
8.6%
Contributions and donations
$124,974
0.1%
Investment income
$555,662
0.5%
Other
$9.3M
8.0%
Other expenses
-$89,481
-0.1%
Net income
-$9.9M
-8.6%
Gross revenue by payer
Line
Amount
Share
Traditional Medicare
$70.8M
20.1%
Medicaid (including managed care)
$36.6M
10.4%
Other payers and self-pay
$245.7M
69.6%
Total charges
$353M
100.0%
Source: CMS cost report (HCRIS, Form 2552-10), report 841966, settled without audit. Hospitals report these figures themselves; they are not audited financial statements. Traditional Medicare is the program charges on Worksheets D-3 and D Part V; Medicaid is from Worksheet S-10.
Financial ratios
Computed from Capital Region Medical Center's latest cost report, which covers 184 days; income and expense figures are scaled to a year.
-17.1%
Operating margin
Operating income from patient care / net patient revenue
-7.9%
Total margin
Net income / net patient revenue plus other income
-1.6%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
Adjusted salaries / paid hours (Worksheet S-3 Part II)
-12.2%
Return on assets
Net income for a year / total assets
-23.9%
Return on equity
Net income for a year / fund balance
0.67
Current ratio
Current assets / current liabilities
0.47
Quick ratio
Cash, temporary investments and net receivables / current liabilities
7 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
40 days
Days in patient receivables
Net patient receivables / daily net patient revenue
95 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
1.55
Asset turnover
Total revenue for a year / total assets
13.6 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 841966, settled without audit. Hospitals report these figures themselves; they are not audited financial statements.
Balance sheet
What Capital Region Medical Center owned and owed at the end of its reporting period (Dec 2023), across all fund types: $161.8M in total assets and a $82.4M fund balance.
Show the balance sheetHide the balance sheet
Line
Amount
Of total assets
Cash and temporary investments
$5.1M
3.2%
Patient receivables, net
$25.5M
15.8%
Inventory
$6.5M
4.0%
Total current assets
$44.4M
27.4%
Property and equipment, net of depreciation
$74.8M
46.2%
Investments and other assets
$42.6M
26.3%
Total assets
$161.8M
100.0%
Current liabilities
$65.9M
40.8%
Total liabilities
$79.4M
49.1%
Fund balance (net assets)
$82.4M
50.9%
Source: CMS cost report (HCRIS, Form 2552-10), report 841966, settled without audit. Hospitals report these figures themselves; they are not audited financial statements.
Charity care and uncompensated care
Care Capital Region Medical Center provided without full payment, as reported on Worksheet S-10 of its cost report.
$4.3M
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$1.2M
Bad debt
Patient bills written off as uncollectible, at charges
$3.5M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$8.2M
Total unreimbursed and uncompensated care
6.0% of operating expenses
Medicaid, CHIP and indigent care shortfalls plus charity care and the cost of bad debt (Worksheet S-10 line 31)
Source: CMS cost report (HCRIS, Form 2552-10), report 841966, settled without audit. Hospitals report these figures themselves; they are not audited financial statements.
Financial trend
Capital Region Medical Center's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
Show 4 yearsHide 4 years
Fiscal year ending
Jun 2020
Jun 2021
Jun 2022
Jun 2023
Net patient revenue
$205.4M
$219.9M
$203.6M
$224M
Operating expenses
$218.9M
$237.8M
$256.1M
$263.7M
Operating margin
-6.5%
-8.2%
-25.8%
-17.7%
Net income
-$1.2M
$8.1M
-$32.8M
-$20.3M
Total assets
$219.6M
$246.9M
$213M
$182M
Discharges
4,794
4,772
4,501
4,265
Inpatient days
16,664
18,613
19,064
16,455
Medicare Advantage days
3,570
3,949
4,848
5,309
Beds
114
114
114
114
Employees (FTE)
1,163
1,203
1,174
1,130
Source: CMS cost report (HCRIS, Form 2552-10), report 841966, settled without audit. Hospitals report these figures themselves; they are not audited financial statements.
Departments
Each cost center Capital Region Medical Center reports, largest first. Total cost includes its share of overhead; the cost-to-charge ratio is total cost / charges.
Show all 58 departmentsHide all 58 departments
Ancillary and outpatient departments
Department
Salaries
Total cost
Charges
Cost-to-charge
Square feet
Drugs charged to patients
$22.6M
$67.3M
0.34
Impl. dev. charged to patients
$6.7M
$7.7M
0.88
Operating room
$1.7M
$6.3M
$42.5M
0.15
35,448
Laboratory
$1.3M
$4.6M
$33.9M
0.14
7,369
Emergency
$1.6M
$4.3M
$34.2M
0.13
17,274
Medical supplies charged to patient
$3.9M
$9.4M
0.41
Physical therapy
$1.8M
$3.8M
$9M
0.43
6,371
Radiology-diagnostic
$2.9M
$3.1M
$21.9M
0.14
13,611
Recovery room
$1M
$2.4M
$4M
0.60
13,474
Oncology
$1.9M
$2.3M
$11.2M
0.21
Ct scan
$281,349
$1.5M
$29.8M
0.05
1,258
Ob gyn associates
$1.4M
$1.2M
$1.6M
0.78
10,368
Cardiac catheterization
$288,245
$1.2M
$10.8M
0.11
5,286
Observation beds (non-distinct part
$1.2M
$2M
0.60
Respiratory therapy
$612,789
$1.1M
$4.8M
0.22
1,248
Internal medicine
$1.4M
$1M
$1.1M
0.90
9,291
Pediatric clinic
$1.3M
$905,085
$736,866
1.23
6,612
Mri
$195,782
$758,046
$8.3M
0.09
2,269
General surgery
$1.1M
$669,535
$777,042
0.86
6,731
Occupational therapy
$396,999
$662,011
$2.8M
0.24
928
Electrocardiology
$191,106
$567,471
$6.1M
0.09
2,739
Neurology clinic
$996,582
$545,834
$1.7M
0.33
3,451
Orthopedic clinic
$203,769
$529,592
$1.1M
0.47
6,485
Ultra sound
$199,149
$488,292
$5.8M
0.08
1,857
Delivery room & labor room
$420,812
$1.2M
0.34
Radioisotope
$128,928
$411,446
$2.1M
0.19
1,745
Speech pathology
$219,310
$349,351
$1.3M
0.27
Electroencephalography
$107,104
$328,308
$1.2M
0.26
3,897
Gi clinic
$244,390
$322,527
$428,615
0.75
3,543
Blood storing processing & trans.
$273,264
$990,212
0.28
Cardiac rehabilitation
$115,293
$255,491
$984,445
0.26
Ent clinic
$58,260
$234,919
$484,921
0.48
3,749
Anesthesiology
$3.2M
$155,265
$5.9M
0.03
1,013
Podiatry clinic
$264,053
$139,090
$595,999
0.23
Vein clinc
$210,052
$104,566
$748,291
0.14
1,517
Rehab clinic
$213,064
$67,118
$87,519
0.77
Pain clinic
$37,162
$54,078
$81,300
0.67
Inpatient units
Department
Salaries
Total cost
Charges
Cost-to-charge
Square feet
Adults & pediatrics
$3.8M
$9M
$14.5M
0.62
50,144
Intensive care unit
$582,652
$1.6M
$2M
0.77
9,129
Subprovider - irf
$716,147
$1.5M
$1.3M
1.14
10,210
Nursery
$221,162
$660,728
0.33
Overhead (general service) departments
Department
Salaries
Direct cost
Paid hours
Average hourly wage
Square feet
Administrative and general
$6.7M
$14.2M
107,640
Cap rel costs-mvble equip
$5M
Central services & supply
$187,104
$4.8M
9,500
$19.73
2,679
Fra administration
$4.4M
Employee benefits department
-$58,778
$4.3M
Cap rel costs-bldg & fixt
$3.1M
412,714
Operation of plant
$290,494
$2.5M
11,989
$24.26
26,103
Pharmacy
$672,283
$2.4M
2,741
Housekeeping
$792,657
$1.2M
45,893
$17.31
2,511
Medical records & library
$669,306
$1.1M
26,200
$25.58
4,602
Dietary
$456,394
$955,385
27,051
$16.91
9,987
Nursing administration
$562,288
$693,800
12,873
$43.72
9,020
Social service
$471,118
$616,517
13,452
$35.04
1,341
I&r services-other prgm costs apprv
$301,248
I&r services-salary & fringes apprv
$465,031
$294,346
2,625
Laundry & linen service
$46,493
$239,711
2,761
$16.89
2,488
Cap rel costs-bldg & fixt #1
$2,073
Source: CMS cost report (HCRIS, Form 2552-10), report 841966, settled without audit. Hospitals report these figures themselves; they are not audited financial statements. Worksheets A, B-1, C Part I and S-3 Part II.
Medicare payment profile
The factors Medicare uses to set what it pays Capital Region Medical Center for an inpatient stay.
1.43
Case mix index
Higher than 19% of hospitals paid under Medicare IPPS
Average Medicare DRG weight of its inpatient cases (FY 2026); higher means more complex, costlier care.
Teaching hospital
Teaching status
0.12 residents per bed
Medicare-funded interns and residents per bed (FY 2026).
21.0%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2026).
340
Medicare inpatient stays
Medicare claims CMS based FY 2026 payment rates on.
Urban (metro area)
Location type
Geographic area CMS assigns before any wage index reclassification (FY 2026).
Show FY 2021 to FY 2026Hide FY 2021 to FY 2026
IPPS fiscal year
FY 2021
FY 2022
FY 2023
FY 2024
FY 2025
FY 2026
Case mix index
1.48
1.48
1.67
1.66
1.48
1.43
Wage index
0.839
0.841
0.838
0.838
0.940
0.967
Readmissions adjustment
-0.46%
-0.65%
-0.88%
-0.64%
-0.52%
-0.21%
Value-based purchasing adjustment
+0.78%
+0.12%
+0.12%
0.00%
0.00%
0.00%
Medicare inpatient stays
2,118
2,118
1,571
1,335
1,240
340
Source: CMS IPPS final rule Impact File (FY 2026).
Ownership
Organizations Capital Region Medical Center reports to Medicare as owners or with operational control.
Changes of ownership
2024-01-01: Sold to Curators of The University of Missouri (Acquisition/merger)
Source: IRS Form 990 Part VII filed by Capital Region Medical Center (EIN 44-0546366), via the IRS e-file data. A health system's return can cover several hospitals.
Programs and facilities
Helipad
Capital Region Medical Center
FAA location ID MU64, a medical-use heliport at the hospital.
Source: FAA National Airspace System Resource data, cycle 2026-10-01.
Hospital-based units
Hospital-based units with their own Medicare certification
About Capital Region Medical Center's rates and hospital price transparency.
How much does an MRI cost at Capital Region Medical Center?
For MRI brain before and after contrast (CPT 70553), published negotiated rates at Capital Region Medical Center range from $278 to $770 across 2 insurers. UnitedHealthcare's rate is $278. The median at nearby comparable hospitals is $657. What a patient pays depends on their plan's deductible, coinsurance and network status.
How much does a CT scan cost at Capital Region Medical Center?
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Capital Region Medical Center range from $278 to $534 across 2 insurers. UnitedHealthcare's rate is $278. The median at nearby comparable hospitals is $575. What a patient pays depends on their plan's deductible, coinsurance and network status.
How much does a colonoscopy cost at Capital Region Medical Center?
For Colonoscopy with polyp removal (CPT 45385), published negotiated rates at Capital Region Medical Center range from $2,110 to $2,789 across 3 insurers. Blue Cross Blue Shield's rate is $2,268. The median at nearby comparable hospitals is $1,193. What a patient pays depends on their plan's deductible, coinsurance and network status.
How much does giving birth cost at Capital Region Medical Center?
For Vaginal delivery, hospital stay (MS-DRG 807), published negotiated rates at Capital Region Medical Center range from $3,489 to $17,192 across 4 insurers. Cigna's rate is $17,192. What a patient pays depends on their plan's deductible, coinsurance and network status.
How much does a mammogram cost at Capital Region Medical Center?
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Capital Region Medical Center range from $79 to $199 across 2 insurers. UnitedHealthcare's rate is $79. The median at nearby comparable hospitals is $146. What a patient pays depends on their plan's deductible, coinsurance and network status.
How much does hip or knee replacement cost at Capital Region Medical Center?
For Major lower-extremity joint replacement without MCC (MS-DRG 470), published negotiated rates at Capital Region Medical Center range from $11,089 to $49,187 across 4 insurers. Aetna's rate is $15,171. The median at nearby comparable hospitals is $19,287. What a patient pays depends on their plan's deductible, coinsurance and network status.
Is Capital Region Medical Center a teaching hospital?
Yes. CMS counts 0.12 Medicare-funded residents per bed at Capital Region Medical Center for fiscal year 2026, so it is a teaching hospital.
Does Medicare penalize Capital Region Medical Center for readmissions?
Yes. Under the Hospital Readmissions Reduction Program, Medicare cuts Capital Region Medical Center's base inpatient payments by an estimated 0.21% in fiscal year 2026 for more readmissions than expected.
What is Capital Region Medical Center's case mix index?
Capital Region Medical Center's Medicare case mix index is 1.43 for fiscal year 2026, higher than 19% of hospitals paid under the inpatient prospective payment system.
How many patients does Capital Region Medical Center admit?
Capital Region Medical Center reported 2,426 inpatient discharges and 8,371 inpatient days from Jul 1, 2023 to Dec 31, 2023.
How many employees does Capital Region Medical Center have?
Capital Region Medical Center reported 611 full-time-equivalent employees on payroll from Jul 1, 2023 to Dec 31, 2023.
How much revenue does Capital Region Medical Center make?
Capital Region Medical Center reported $116.1M in net patient revenue on $410.6M of gross charges for Jul 1, 2023 to Dec 31, 2023, an operating margin of -17.1%, and net income of -$9.9M.
How much charity and uncompensated care does Capital Region Medical Center provide?
Capital Region Medical Center reported $8.2M of unreimbursed and uncompensated care for Jul 1, 2023 to Dec 31, 2023, including $4.3M of charity care at cost.
Who is the CEO of Capital Region Medical Center?
Capital Region Medical Center's 2024 IRS Form 990 lists Randall Haight as Vice President/physician.
What is Capital Region Medical Center's tax ID (EIN)?
Insurers' price transparency files list Capital Region Medical Center under employer identification number 44-0546366 (Capital Region Medical Center), and 1 other tax ID. 40 health plans and networks list 44-0546366 for it.
What services does Capital Region Medical Center offer?
CMS lists 28 services at Capital Region Medical Center, including Acute Renal Dialysis, Adult Inpatient Psychiatric Care, Alcohol and/or Drug Service, Anesthesia, Cardiac Thoracic Surgery, Clinical Laboratory.
How many beds does Capital Region Medical Center have?
Capital Region Medical Center has 114 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. Facility type: Short Term Acute Care Hospital.
Where is Capital Region Medical Center and what is its phone number?
Capital Region Medical Center is located at 1125 Madison Street, Jefferson City, MO 65101. Its main phone number is (573) 632-5000.
What is Capital Region Medical Center's CCN (Medicare provider number)?
Capital Region Medical Center's CMS Certification Number (CCN), also called its Medicare provider number, is 260047.
What is Capital Region Medical Center's NPI number?
The National Provider Identifier (NPI) on file for Capital Region Medical Center is 1174597892.
What health system is Capital Region Medical Center part of?
Capital Region Medical Center is affiliated with University of Missouri Health Care.
Which insurance plans are in network at Capital Region Medical Center?
Capital Region Medical Center lists 24 in-network payers, including Aetna, Aspirus Health Plan, BCBS, Banner Health, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
What price transparency data is available for Capital Region Medical Center?
422 disclosed rate categories. Each shows the payer, category, code type and group with its code range, and contract type, along with how the rate compares with the state average.
What is a hospital price transparency MRF?
Under 45 CFR Part 180, every US hospital must publish a machine-readable file of its standard charges, including gross charges, discounted cash prices and payer-specific negotiated rates, in the CMS template format. PayerPrice can help hospitals publish and maintain these files.
What is a chargemaster review?
A chargemaster (charge description master, or CDM) is a hospital's master list of billable items, with codes, descriptions and gross charges. A chargemaster review looks at those lines for accuracy and pricing. PayerPrice can help hospitals review their chargemaster; contact us to discuss your needs.
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We turn your chargemaster and payer contracts into the CMS template file, then keep it current as rates change.
Get your chargemaster right for billing and payer contracts
Your chargemaster sets the gross charge on every claim, and many payer contracts base payment on it through percent-of-charge, lesser-of and stop-loss terms. We audit it line by line and show how your charges and negotiated rates compare with peer hospitals before your next negotiation.
What a review covers
CodingPricingPayer contractsCompliance
CPT, HCPCS, revenue code and modifier errors flagged line by line
Missing, duplicate and outdated charge lines identified
Charges set below payer allowables caught before lesser-of clauses cut payment
Revenue impact of charge changes modeled across percent-of-charge and stop-loss terms
Your negotiated rates benchmarked against peer hospitals for the same payers