Medicine & Surgery · Inpatient
Cervical spinal fusion without CC or MCC
MS-DRG 473
$18,442
negotiated rate
Hospital reports orthopedic surgery services to CMS
Luverne, AL
Not rated by CMS
CMS star rating
49
Beds
104
Inpatient discharges a year
$3.9M
Net patient revenue a year
32
In-network payers
Crenshaw Community Hospital is a 49-bed proprietary hospital in Luverne, AL. Below you'll find publicly disclosed negotiated rates and facility details, including 32 in-network payers and 144 disclosed rate categories.
The 24 services Crenshaw Community Hospital 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.
Book a demo to see hidden insurer names, more payer rates, and hospital data, or start a free trial.
Medicine & Surgery · Inpatient
MS-DRG 473
$18,442
negotiated rate
Hospital reports orthopedic surgery services to CMS
Medicine & Surgery · Inpatient
MS-DRG 470
$14,507
negotiated rate
Hospital reports orthopedic surgery services to CMS
CT imaging
CPT 70450
$90 - $660
from 3 insurers · median $516
Common here, based on CMS Medicare volume
CT imaging
CPT 74177
$475 - $1,980
from 3 insurers · median $516
Common here, based on CMS Medicare volume
Medicine & Surgery · Inpatient
MS-DRG 743
$9,107
negotiated rate
Hospital reports inpatient surgical services to CMS
CT imaging
CPT 74176
$475 - $516
from 2 insurers · median $496
Common here, based on CMS Medicare volume
Cardiology and vascular testing
CPT 93306
$427 - $758
from 2 insurers · median $593
Common here, based on CMS Medicare volume
Digestive procedures
CPT 43239
$776 - $1,562
from 3 insurers · median $1,100
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45385
$776 - $1,525
from 3 insurers · median $1,100
Common here, based on CMS Medicare volume
Mammography
CPT 77067
$83 - $114
from 2 insurers · median $99
Common here, based on CMS Medicare volume
CT imaging
CPT 71275
$241 - $632
from 2 insurers · median $436
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45378
$776 - $1,190
from 3 insurers · median $938
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 47562
$2,451 - $5,949
from 2 insurers · median $4,200
Typical for a hospital with this service line
Digestive procedures
CPT 45380
$776 - $1,585
from 3 insurers · median $1,100
Common here, based on CMS Medicare volume
MRI imaging
CPT 70553
$417 - $729
from 2 insurers · median $573
Common here, based on CMS Medicare volume
Gynecology
CPT 58661
$2,451 - $10,348
from 2 insurers · median $6,399
Typical for a hospital with this service line
MRI imaging
CPT 72148
$416 - $525
from 2 insurers · median $470
Common here, based on CMS Medicare volume
Gynecology
CPT 58571
$9,752
negotiated rate
Typical for a hospital with this service line
MRI imaging
CPT 73721
$525 - $616
from 2 insurers · median $571
Common here, based on CMS Medicare volume
X-ray and bone density
CPT 71046
$29 - $93
from 2 insurers · median $61
Common here, based on CMS Medicare volume
Lung function and sleep
CPT 95810
$380 - $1,244
from 2 insurers · median $812
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 66984
$1,100 - $2,762
from 3 insurers · median $1,425
Typical for a hospital with this service line
Gynecology
CPT 58662
$2,451 - $8,075
from 2 insurers · median $5,263
Typical for a hospital with this service line
Cardiology and vascular testing
CPT 93970
$306 - $426
from 2 insurers · median $366
Common here, based on CMS Medicare volume
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* | 5 | 587% | 5 | 0 |
| Insurer B* | 21 | 136% | 19 | 2 |
| Insurer C* | 17 | 117% | 2 | 14 |
| Insurer D* | 8 | 62% | 2 | 6 |
How we chose these services: 0 appear in this hospital's own Medicare claims, 16 are common here based on CMS Medicare volume, and 8 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 Crenshaw Community Hospital, or start a free trial.
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.





Quality
Not rated by CMS
See quality ratingsDoctors and services
16 services
See doctors and servicesFinances
$3.9M net patient revenue
The employer identification numbers (EINs) health plans and networks list for Crenshaw Community Hospital 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 |
|---|---|---|
| 20-2318944Crenshaw County Health Care Authority | 43Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Allied Benefit Systems, Ambetter and 38 more | 1750480406 Crenshaw County Health Care Authority1851487656 Crenshaw County Health Care Authority1194811901 Crenshaw County Health Care Authorityand 1 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.
101 Hospital Circle, Luverne, AL 36049
(334) 335-3374
How Crenshaw Community Hospital compares with other US facilities on the measures CMS publishes, mostly from Medicare patients.
Hospital-acquired condition penalty
Not penalized
Not among the worst-performing 25%
Medicare cuts payments 1% for the worst-performing 25% of hospitals on infections and injuries acquired in the hospital
| Measure | Result | Period |
|---|---|---|
| Hospital-acquired condition penaltyCMS: HAC Reduction Program payment reduction | Not penalized | 2026 |
Source: CMS Provider Data Catalog, released 2026-08-13. US comparisons rank this facility among every facility CMS reports for each measure. See Medicare Care Compare.
Each result CMS publishes for Crenshaw Community Hospital, beside the US median and the average of AL hospitals. The rank says what share of US hospitals the result is better or worse than; counts and confidence limits are not ranked.
Excess readmission ratios by condition; above 1 means more readmissions than expected.
| Measure | Crenshaw Community Hospital | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| READM-30-AMI-HRRP2021-07-01 to 2024-06-30 | N/A | 1.029 | |||
| READM-30-CABG-HRRP2021-07-01 to 2024-06-30 | N/A | 1.045 | |||
| READM-30-COPD-HRRP2021-07-01 to 2024-06-30 | N/A | 0.996 | |||
| READM-30-HF-HRRP2021-07-01 to 2024-06-30 | N/A | 1.009 | |||
| READM-30-HIP-KNEE-HRRP2021-07-01 to 2024-06-30 | N/A | 1.039 | |||
| READM-30-PN-HRRP2021-07-01 to 2024-06-30 | 1.002 | 0.9955 | 1.003 | Worse than 54% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| READM-30-AMI-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-CABG-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-COPD-HRRP | 0.9889 | 0.9878 | N/A | N/A | N/A | N/A |
| READM-30-HF-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-HIP-KNEE-HRRP | N/A | N/A | N/A | N/A | N/A | N/A |
| READM-30-PN-HRRP | 0.9655 | 0.9742 | N/A | N/A | N/A | 1.002 |
Infection ratios, the PSI 90 composite and the total score Medicare ranks hospitals on; lower is better.
| Measure | Crenshaw Community Hospital | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| CAUTI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.5999 | |||
| CDI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.4007 | |||
| CLABSI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.8784 | |||
| HAC Reduction Program payment reductionFY 2026 | No | ||||
| MRSA standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.8744 | |||
| Patient safety and adverse events composite (PSI 90)2022-07-01 to 2024-06-30 | N/A | 1.049 | |||
| SSI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.5688 | |||
| Total HAC scoreFY 2026 | N/A | 0.09962 |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| HAC Reduction Program payment reduction | No | No | N/A | No | No | No |
| Total HAC score | 0.0247 | 0.0445 | 0 | N/A | N/A | N/A |
Source: CMS Care Compare hospital files, latest release 2026-08-13, with program results for earlier fiscal years from CMS's archived snapshots. US medians and ranks count every hospital CMS reports; state averages are plain means of the state's reporting hospitals, not CMS's patient-weighted state rates.
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What Crenshaw Community Hospital reported to Medicare in its latest cost report, covering Oct 1, 2024 to Feb 10, 2025.
104
Inpatient discharges
Medicare 31%, Medicaid 13%
459
Inpatient days
12% of available bed days used
100
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 813747). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges Crenshaw Community Hospital reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 152 | 48 | 259 | 459 |
| Discharges | 32 | 13 | 59 | 104 |
| Average length of stay | 4.8 days | 3.7 days | 4.4 days | 4.4 days |
| Average daily census | 1.1 | 0.4 | 1.9 | 3.5 |
218
Medicare Advantage days
59
Medicaid managed care days
285
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 29 | 459 | 152 | 12% |
| Subprovider - ipf | 20 | 1,436 | 106 | 54% |
Source: CMS cost report (HCRIS, Form 2552-10), report 813747, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
What Crenshaw Community Hospital treats Medicare patients for most often, in 2024. 13 Medicare discharges in 1 published DRGs; 0% surgical; 0% in DRGs with complications (CC or MCC).
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 13 | $16,002 | $5,699 | $6,321 | 0.81 |
Source: CMS Medicare Inpatient Hospitals by Provider and Service (2024 data, released 2026-04-10), traditional Medicare only; CMS omits DRGs with fewer than 11 discharges. Estimated cost is average charges times the hospital's Medicare cost-to-charge ratio from the IPPS Impact File. Weights are the MS-DRG relative weights for the same year.
The comprehensive outpatient service groups (APCs) Crenshaw Community Hospital billed Medicare for most in 2024: 36 services in all.
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Comprehensive Observation ServicesAPC 8011 | 36 | 26 | $10,956 | $1,786 | $2,090 |
Source: CMS Medicare Outpatient Hospitals by Provider and Service (2024 data, released 2026-06-24), comprehensive APCs for traditional Medicare; CMS omits services with fewer than 11 claims. The US average weights every hospital by its services.
Revenue, expenses and income Crenshaw Community Hospital reported to Medicare for Oct 1, 2024 to Feb 10, 2025. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $14.2M | 359.1% |
| Inpatient | $4.2M | 107.2% |
| Outpatient | $9.9M | 251.9% |
| Contractual allowances and discounts | -$10.2M | -259.1% |
| Net patient revenue | $3.9M | 100.0% |
| Operating expenses | -$5.6M | -142.2% |
| Operating income from patient care | -$1.7M | -42.2% |
| Other income | $660,652 | 16.7% |
| Net income | -$1M | -25.4% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $1.3M | 9.2% |
| Medicaid (including managed care) | $783,163 | 5.6% |
| Other payers and self-pay | $11.8M | 85.1% |
| Total charges | $13.9M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 813747, as submitted. 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.
Computed from Crenshaw Community Hospital's latest cost report, which covers 133 days; income and expense figures are scaled to a year.
-42.2%
Operating margin
Operating income from patient care / net patient revenue
-21.8%
Total margin
Net income / net patient revenue plus other income
-19.6%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
56% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$27.12
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
498.5%
Return on assets
Net income for a year / total assets
-1.04
Current ratio
Current assets / current liabilities
-11.03
Quick ratio
Cash, temporary investments and net receivables / current liabilities
-19 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
-150 days
Days in patient receivables
Net patient receivables / daily net patient revenue
11 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
-22.89
Asset turnover
Total revenue for a year / total assets
0.4 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 813747, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
What Crenshaw Community Hospital owned and owed at the end of its reporting period (Feb 2025), across all fund types: -$552,647 in total assets and a -$1M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | -$772,411 | |
| Patient receivables, net | -$4.5M | |
| Inventory | $78,219 | |
| Total current assets | -$489,997 | |
| Property and equipment, net of depreciation | -$62,650 | |
| Total assets | -$552,647 | |
| Current liabilities | $473,423 | |
| Long-term debt | -$22,178 | |
| Total liabilities | $451,245 | |
| Fund balance (net assets) | -$1M |
Source: CMS cost report (HCRIS, Form 2552-10), report 813747, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Care Crenshaw Community Hospital provided without full payment, as reported on Worksheet S-10 of its cost report.
$959,848
Bad debt
Patient bills written off as uncollectible, at charges
-$100,153
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$312,573
Total unreimbursed and uncompensated care
5.6% 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 813747, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Crenshaw Community Hospital's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Dec 2019 | Dec 2020 | Dec 2021 | Dec 2022 | Sep 2024 |
|---|---|---|---|---|---|
| Net patient revenue | $10.3M | $9.8M | $8.4M | $10.2M | |
| Operating expenses | $12.5M | $9.8M | $15M | $14.9M | $13.8M |
| Operating margin | -20.9% | -52.7% | -77.2% | -35.8% | |
| Net income | -$887,164 | -$9.8M | -$1.7M | -$3.9M | $1M |
| Total assets | $4.9M | $25.8M | $2.6M | $5.2M | |
| Discharges | 376 | 234 | 353 | 291 | 329 |
| Inpatient days | 1,609 | 1,291 | 1,738 | 1,335 | 1,499 |
| Medicare Advantage days | 279 | 359 | 456 | 786 | |
| Beds | 49 | 49 | 49 | 49 | 49 |
| Employees (FTE) | 93 | 65 | 125 | 99 | 81 |
Source: CMS cost report (HCRIS, Form 2552-10), report 813747, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center Crenshaw Community Hospital reports, largest first. Total cost includes its share of overhead; the cost-to-charge ratio is total cost / charges.
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Emergency | $333,307 | $717,641 | $3.7M | 0.19 | 13,400 |
| Laboratory | $222,086 | $587,000 | $2.4M | 0.24 | 672 |
| Radiology-diagnostic | $153,571 | $318,883 | $2.5M | 0.13 | 1,804 |
| Operating room | $85,458 | $287,435 | $262,435 | 1.10 | 4,160 |
| Rural health clinic | $104,893 | $261,099 | $115,317 | 2.26 | 2,635 |
| Drugs charged to patients | $67,828 | $247,123 | $1.3M | 0.19 | 672 |
| Observation beds (non-distinct part | $234,162 | $585,432 | 0.40 | ||
| Respiratory therapy | $118,663 | $237,034 | 0.50 | 2,574 | |
| Medical supplies charged to patient | $29,509 | $79,982 | $80,745 | 0.99 | 704 |
| Pain management clinic | $23,306 | $42,947 | $65,081 | 0.66 | |
| Clinic | $4,662 | $27,902 | $788 | 35.41 | 1,250 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Subprovider - ipf | $671,349 | $1.2M | $2M | 0.61 | 7,905 |
| Adults & pediatrics | $309,333 | $611,287 | $614,050 | 1.00 | 11,531 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Administrative & general | $278,796 | $784,704 | 14,546 | $19.18 | 2,448 |
| Employee benefits department | $537,435 | ||||
| Nursing administration | $230,350 | $241,612 | 6,300 | $36.56 | |
| Dietary | $76,671 | $125,511 | 5,264 | $14.56 | 2,172 |
| Cap rel costs-mvble equip | $101,954 | ||||
| Operation of plant | $50,137 | $87,329 | 4,047 | $12.39 | 1,860 |
| Medical records & library | $44,308 | $58,760 | 2,645 | $16.75 | 576 |
| Housekeeping | $53,271 | $54,284 | 4,206 | $12.66 | 174 |
| Laundry & linen service | $28,170 | 174 |
Source: CMS cost report (HCRIS, Form 2552-10), report 813747, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheets A, B-1, C Part I and S-3 Part II.
Crenshaw comm hosp psych unit
CCN 01S008, certified 1985, Medicare prospective payment
Crenshaw community hospital
CCN 01U008, certified 1989, Medicare prospective payment
The hospital home care
CCN 017140, certified 1994, Medicare prospective payment
Crenshaw county rhc
CCN 013482, certified 2020, Medicare not participating
Source: Worksheet S-2 Part I of Crenshaw Community Hospital's latest Medicare cost report (HCRIS).
About Crenshaw Community Hospital's rates and hospital price transparency.
For MRI brain before and after contrast (CPT 70553), published negotiated rates at Crenshaw Community Hospital range from $417 to $729 across 2 insurers. Aetna's rate is $417. The median at nearby comparable hospitals is $1,147. What a patient pays depends on their plan's deductible, coinsurance and network status.
For CT head or brain without contrast (CPT 70450), published negotiated rates at Crenshaw Community Hospital range from $90 to $660 across 3 insurers. Aetna's rate is $90. The median at nearby comparable hospitals is $325. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Colonoscopy with polyp removal (CPT 45385), published negotiated rates at Crenshaw Community Hospital range from $776 to $1,525 across 3 insurers. Blue Cross Blue Shield's rate is $1,525. The median at nearby comparable hospitals is $1,326. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Crenshaw Community Hospital range from $83 to $114 across 2 insurers. Blue Cross Blue Shield's rate is $83. The median at nearby comparable hospitals is $128. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Major lower-extremity joint replacement without MCC (MS-DRG 470), published negotiated rates at Crenshaw Community Hospital range from $14,507 to $14,507 across 1 insurers. Cigna's rate is $14,507. The median at nearby comparable hospitals is $11,257. What a patient pays depends on their plan's deductible, coinsurance and network status.
In 2024, the most common were kidney and urinary tract infections without mcc (13 discharges).
Crenshaw Community Hospital reported 104 inpatient discharges and 459 inpatient days from Oct 1, 2024 to Feb 10, 2025.
Crenshaw Community Hospital reported 100 full-time-equivalent employees on payroll from Oct 1, 2024 to Feb 10, 2025.
Crenshaw Community Hospital reported $3.9M in net patient revenue on $14.2M of gross charges for Oct 1, 2024 to Feb 10, 2025, an operating margin of -42.2%, and net income of -$1M.
Crenshaw Community Hospital reported $312,573 of unreimbursed and uncompensated care for Oct 1, 2024 to Feb 10, 2025.
Insurers' price transparency files list Crenshaw Community Hospital under employer identification number 20-2318944 (Crenshaw County Health Care Authority). 43 health plans and networks list 20-2318944 for it.
CMS lists 16 services at Crenshaw Community Hospital, including Adult Inpatient Psychiatric Care, Anesthesia, Clinical Laboratory, CT Scan, Diagnostic Radiology, Dietary Care.
Crenshaw Community Hospital has 49 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. Facility type: Short Term Acute Care Hospital.
Crenshaw Community Hospital is located at 101 Hospital Circle, Luverne, AL 36049. Its main phone number is (334) 335-3374.
Crenshaw Community Hospital's CMS Certification Number (CCN), also called its Medicare provider number, is 010008.
The National Provider Identifier (NPI) on file for Crenshaw Community Hospital is 1750480406.
Crenshaw Community Hospital lists 32 in-network payers, including Aetna, Ambetter, Ameri Health, Aspirus Health Plan, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
144 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.
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.
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.
For hospital finance and compliance teams
The data on this page comes from the files hospitals and payers publish. We help hospitals publish theirs correctly, and take a fresh look at their chargemaster.
We turn your chargemaster and payer contracts into the CMS template file, then keep it current as rates change.
{
"description": "MRI of brain (no contrast)",
"code_information": [
{ "code": "611", "type": "RC" },
{ "code": "70551", "type": "CPT" }
],
"standard_charges": [{
"setting": "outpatient",
"minimum": 250,
"maximum": 400,
"gross_charge": 1200,
"discounted_cash": 1080,
"payers_information": [
{
"payer_name": "Platform Health Insurance",
"plan_name": "PPO",
"methodology": "fee schedule",
"standard_charge_dollar": 400
},
{
"payer_name": "Region Health Insurance",
"plan_name": "HMO",
"methodology": "fee schedule",
"standard_charge_dollar": 250
}
]
}]
}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