Scottsboro, AL
3 of 5
CMS star rating
95
Beds
2,173
Inpatient discharges a year
$41M
Net patient revenue a year
21
In-network payers
Highlands Medical Center is a 95-bed government - hospital district or authority hospital in Scottsboro, AL. Below you'll find publicly disclosed negotiated rates and facility details, including 21 in-network payers and 285 disclosed rate categories.
The 24 services Highlands 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.
Book a demo to see hidden insurer names, more payer rates, and hospital data, or start a free trial.
Childbirth · Inpatient
MS-DRG 807
$3,176 - $8,521
from 3 insurers · median $4,401
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 neonatal nursery services to CMS
Childbirth · Inpatient
MS-DRG 788
$3,176 - $10,913
from 3 insurers · median $4,066
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 neonatal nursery services to CMS
Medicine & Surgery · Inpatient
MS-DRG 470
$5,642 - $23,250
from 3 insurers · median $22,827
11 Medicare discharges for this DRG in CMS hospital data
Childbirth · Inpatient
MS-DRG 807
$3,176 - $8,521
from 3 insurers · median $4,401
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 neonatal nursery services to CMS
Medicine & Surgery · Inpatient
MS-DRG 473
$7,141 - $29,309
from 2 insurers · median $18,225
Hospital reports orthopedic surgery services to CMS
Medicine & Surgery · Inpatient
MS-DRG 460
$41,912
negotiated rate
Hospital reports orthopedic surgery services to CMS
CT imaging
CPT 74177
$157 - $580
from 4 insurers · median $421
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45378
$1,122 - $3,902
from 4 insurers · median $2,464
Common here, based on CMS Medicare volume
Gynecology
CPT 58571
$10,475 - $12,830
from 2 insurers · median $11,653
Typical for a hospital with this service line
Digestive procedures
CPT 43239
$277 - $3,333
from 4 insurers · median $1,408
Common here, based on CMS Medicare volume
Urology
CPT 50590
$1,329 - $17,870
from 4 insurers · median $5,379
23 Medicare claims in Level 4 Urology and Related Services (CMS 2024)
Cardiology and vascular testing
CPT 93306
$341 - $901
from 4 insurers · median $677
Common here, based on CMS Medicare volume
Medicine & Surgery
CPT 66984
$1,036 - $5,862
from 4 insurers · median $3,085
32 Medicare claims in Level 1 Intraocular Procedures (CMS 2024)
Medicine & Surgery
CPT 47562
$6,460 - $17,000
from 3 insurers · median $7,297
Typical for a hospital with this service line
Digestive procedures
CPT 45385
$509 - $3,333
from 4 insurers · median $1,675
Common here, based on CMS Medicare volume
Digestive procedures
CPT 45380
$403 - $3,333
from 3 insurers · median $1,444
Common here, based on CMS Medicare volume
CT imaging
CPT 70450
$126 - $560
from 4 insurers · median $152
Common here, based on CMS Medicare volume
Mammography
CPT 77067
$91 - $122
from 3 insurers · median $107
Common here, based on CMS Medicare volume
Orthopedics and pain
CPT 64721
$2,357 - $6,427
from 4 insurers · median $2,967
27 Medicare claims in Level 1 Nerve Procedures (CMS 2024)
Nuclear imaging
CPT 78452
$581 - $2,900
from 4 insurers · median $1,728
Common here, based on CMS Medicare volume
Gynecology
CPT 58558
$3,907 - $8,929
from 4 insurers · median $5,471
Typical for a hospital with this service line
CT imaging
CPT 74176
$157 - $621
from 4 insurers · median $272
Common here, based on CMS Medicare volume
X-ray and bone density
CPT 71046
$43 - $115
from 4 insurers · median $101
Common here, based on CMS Medicare volume
Gynecology
CPT 58661
$7,297 - $11,193
from 3 insurers · median $7,662
Typical for a hospital with this service line
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* | 20 | 150% | 14 | 0 |
| Insurer B* | 23 | 147% | 6 | 9 |
| Insurer C* | 15 | 118% | 6 | 9 |
| Insurer D* | 23 | 118% | 4 | 13 |
How we chose these services: 4 appear in this hospital's own Medicare claims, 11 are common here based on CMS Medicare volume, and 9 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 Highlands Medical Center, or start a free trial.
Acceptance varies by plan and service. Confirm coverage with your insurer or the hospital's billing department.
Quality
3 of 5 stars
Doctors and services
Accredited by ACHC
Finances
$41M net patient revenue
Ownership and leadership
Owned by The Health Care Authority Of The City Of Huntsville
The employer identification numbers (EINs) health plans and networks list for Highlands 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 |
|---|---|---|
| 63-6004388(multi-state) Highlands Medical Center | 29Aetna, Allied Benefit Systems, Aspirus Health Plan, Asuris Northwest Health, BCBS and 24 more | 1659473916 Jackson County Healthcare Authority1871757443 Jackson County Health Care Authority1306941604 Jackson County Healthcare Authorityand 6 more |
| 87-2027148(multi-state) Hh Health System-Jackson LLC | 22Aetna, Cigna, Allied Benefit Systems, Aspirus Health Plan, Banner Health and 17 more | 1699444976 Hh Health System - Jackson LLC1093484396 Hh Health System - Jackson LLC1982300422 Hh Health System - Jackson LLCand 8 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.
380 Woods Cove Road, Scottsboro, AL 35768
(256) 259-4444
How Highlands Medical Center compares with other US facilities on the measures CMS publishes, mostly from Medicare patients.
Overall star rating
3 of 5
Lower than 42% of US hospitals
Combines death rates, safety, readmissions, patient experience and timely care
Death rates
No different on 5 measures
0 better, 5 no different, 0 worse than the US rate
Deaths within 30 days, such as after a heart attack, pneumonia or stroke
Safety
Better on 1 of 2 measures
1 better, 1 no different, 0 worse than the US rate
Infections, surgical complications and other harm in the hospital
Readmissions
Better on 1 of 6 measures
1 better, 5 no different, 0 worse than the US rate
Patients back in the hospital or ER soon after leaving
Patient survey rating
4 of 5
Higher than 60% of US hospitals
From the HCAHPS survey of recent inpatients
Would definitely recommend
62%
Lower than 81% of US hospitals
US median: 71%
Surveyed patients who would definitely recommend the hospital
Hospital-acquired condition penalty
Penalized
Among the worst-performing 25% of US hospitals
Medicare cuts payments 1% for the worst-performing 25% of hospitals on infections and injuries acquired in the hospital
Serious complications (PSI 90)
1
Higher than 66% of US hospitals
US median: 0.96
Risk-adjusted composite of complications such as bedsores, falls with hip fracture and blood clots after surgery; lower is better
Time in the ER before going home
176 min
Higher than 68% of US hospitals
US median: 148 min
Median minutes from arrival to leaving for ER patients who were sent home; lower is better
Sepsis care
42%
Lower than 90% of US hospitals
US median: 65%
Patients with severe sepsis or septic shock who got every step of the recommended early treatment; higher is better
| Measure | Result | Period |
|---|---|---|
| Overall star ratingCMS: Overall hospital quality star rating | 3 of 5 | |
| Death rates | No different on 5 measures | |
| Safety | Better on 1 of 2 measures | |
| Readmissions | Better on 1 of 6 measures | |
| Patient survey ratingCMS: Summary star rating | 4 of 5 | 2024-10-01 to 2025-09-30 |
| Would definitely recommendCMS: "YES", patients would definitely recommend the hospital | 62% | 2024-10-01 to 2025-09-30 |
| Hospital-acquired condition penaltyCMS: HAC Reduction Program payment reduction | Penalized | 2026 |
| Serious complications (PSI 90)CMS: Patient safety and adverse events composite (PSI 90) | 1 | 2022-07-01 to 2024-06-30 |
| Time in the ER before going homeCMS: Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better | 176 min | 2024-10-01 to 2025-09-30 |
| Sepsis careCMS: Appropriate care for severe sepsis and septic shock | 42% | 2024-10-01 to 2025-09-30 |
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.
How Medicare adjusts Highlands Medical Center's inpatient payments for its readmissions, quality and cost results.
-0.02% on Medicare payments
Readmissions penalty
Hospital Readmissions Reduction Program adjustment for excess readmissions, as estimated in the FY 2027 IPPS final rule.
+0.66% on Medicare payments
Value-based purchasing
Hospital Value-Based Purchasing bonus or reduction for quality and cost, as estimated in the FY 2027 IPPS final rule.
Source: CMS IPPS final rule Impact File (FY 2027).
Each result CMS publishes for Highlands Medical Center, 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.
Risk-adjusted 30-day death rates and surgical complications; lower is better.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Rate of complications for hip/knee replacement patients2023-04-01 to 2025-03-31 | Not Available | 4.469 | |||
| Hybrid Hospital-Wide All-Cause Risk Standardized Mortality Rate2024-07-01 to 2025-06-30 · 519 cases | 5 | 3.9 | 4.658 | Worse than 89% of US hospitals | |
| Death rate for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 12.46 | |||
| Death rate for CABG surgery patients2022-07-01 to 2025-06-30 | Not Available | 2.7 | |||
| Death rate for COPD patients2022-07-01 to 2025-06-30 · 41 cases | 9.7 | 8.5 | 8.869 | Worse than 79% of US hospitals | |
| Death rate for heart failure patients2022-07-01 to 2025-06-30 · 51 cases | 12 | 11 | 11.65 | Worse than 69% of US hospitals | |
| Death rate for pneumonia patients2022-07-01 to 2025-06-30 · 106 cases | 17.2 | 15.2 | 16.81 | Worse than 78% of US hospitals | |
| Death rate for stroke patients2023-07-01 to 2025-06-30 · 42 cases | 17.5 | 11.6 | 14.25 | Worse than 96% of US hospitals | |
| Pressure ulcer rate2022-07-01 to 2024-06-30 · 850 cases | 0.48 | 0.51 | 0.6234 | No Different Than the National Rate | Better than 55% of US hospitals |
| Death rate among surgical inpatients with serious treatable complications2022-07-01 to 2024-06-30 | Not Available | 184 | Number of Cases Too Small | ||
| Iatrogenic pneumothorax rate2022-07-01 to 2024-06-30 · 1,020 cases | 0.2 | 0.2 | 0.2114 | No Different Than the National Rate | Better than 46% of US hospitals |
| In-hospital fall-associated fracture rate2022-07-01 to 2024-06-30 · 977 cases | 0.26 | 0.27 | 0.2777 | No Different Than the National Rate | Better than 54% of US hospitals |
| Postoperative hemorrhage or hematoma rate2022-07-01 to 2024-06-30 · 125 cases | 2.31 | 2.29 | 2.258 | No Different Than the National Rate | Worse than 55% of US hospitals |
| Postoperative acute kidney injury requiring dialysis rate2022-07-01 to 2024-06-30 · 42 cases | 1.67 | 1.63 | 1.702 | No Different Than the National Rate | Worse than 72% of US hospitals |
| Postoperative respiratory failure rate2022-07-01 to 2024-06-30 · 43 cases | 9.01 | 8.88 | 10.91 | No Different Than the National Rate | Worse than 53% of US hospitals |
| Perioperative pulmonary embolism or deep vein thrombosis rate2022-07-01 to 2024-06-30 · 129 cases | 3.33 | 3.4 | 3.831 | No Different Than the National Rate | Better than 57% of US hospitals |
| Postoperative sepsis rate2022-07-01 to 2024-06-30 · 34 cases | 7.05 | 5.105 | 5.911 | No Different Than the National Rate | Worse than 93% of US hospitals |
| Postoperative wound dehiscence rate2022-07-01 to 2024-06-30 | Not Available | 1.803 | Number of Cases Too Small | ||
| Abdominopelvic accidental puncture or laceration rate2022-07-01 to 2024-06-30 · 77 cases | 1.04 | 1.02 | 1.058 | No Different Than the National Rate | Worse than 57% of US hospitals |
Unplanned returns to a hospital after a stay or an outpatient procedure; lower is better.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Hospital return days for heart attack patients2022-07-01 to 2025-06-30 | Not Available | 2.616 | |||
| Hospital return days for heart failure patients2022-07-01 to 2025-06-30 · 53 cases | -21.7 | 1.25 | 11.68 | Better than 81% of US hospitals | |
| Hospital return days for pneumonia patients2022-07-01 to 2025-06-30 · 113 cases | 26.2 | 3.85 | 12.55 | Worse than 78% of US hospitals | |
| Hybrid Hospital-Wide All-Cause Readmission Measure (HWR)2024-07-01 to 2025-06-30 | Not Available | ||||
| Rate of unplanned hospital visits after colonoscopy (per 1,000 colonoscopies)2022-01-01 to 2024-12-31 · 298 cases | 12.1 | 12.9 | 12.93 | No Different Than the National Rate | Better than 89% of US hospitals |
| Rate of inpatient admissions for patients receiving outpatient chemotherapy2024-01-01 to 2024-12-31 | Not Available | 10.28 | Number of Cases Too Small | ||
| Rate of emergency department (ED) visits for patients receiving outpatient chemotherapy2024-01-01 to 2024-12-31 | Not Available | 5.113 | Number of Cases Too Small | ||
| Ratio of unplanned hospital visits after hospital outpatient surgery2024-01-01 to 2024-12-31 · 77 cases | 1.1 | 1 | 0.986 | No Different than expected | Worse than 69% of US hospitals |
| Acute Myocardial Infarction (AMI) 30-Day Readmission Rate2023-07-01 to 2025-06-30 | Not Available | 14.31 | |||
| Rate of readmission for CABG2023-07-01 to 2025-06-30 | Not Available | 11.67 | |||
| Rate of readmission for chronic obstructive pulmonary disease (COPD) patients2023-07-01 to 2025-06-30 · 88 cases | 21.1 | 19.8 | 19.89 | Worse than 89% of US hospitals | |
| Heart failure (HF) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 84 cases | 21.7 | 21.3 | 21.29 | Worse than 61% of US hospitals | |
| Rate of readmission after hip/knee replacement2023-07-01 to 2025-06-30 | Not Available | 5.979 | |||
| Pneumonia (PN) 30-Day Readmission Rate2023-07-01 to 2025-06-30 · 153 cases | 17.3 | 17.2 | 17.3 | Worse than 50% of US hospitals |
Standardized infection ratios (1 is the US baseline) and the counts behind them; lower is better.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Central Line Associated Bloodstream Infection (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.3169 | |||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 1.803 | |||
| Central Line Associated Bloodstream Infection: Number of Device Days2024-10-01 to 2025-09-30 | 410 | 1,370 | 3,994 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.259 | 0.9835 | 4.09 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 2.932 | ||
| Central Line Associated Bloodstream Infection (ICU + select Wards)2024-10-01 to 2025-09-30 | Not Available | 0.6373 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.1812 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 1.656 | |||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Number of Urinary Catheter Days2024-10-01 to 2025-09-30 | 1,264 | 1,799 | 5,240 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Predicted Cases2024-10-01 to 2025-09-30 | 0.697 | 1.377 | 6.563 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards): Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 3.286 | ||
| Catheter Associated Urinary Tract Infections (ICU + select Wards)2024-10-01 to 2025-09-30 | Not Available | 0.5151 | |||
| SSI - Colon Surgery: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.2584 | |||
| SSI - Colon Surgery: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.032 | |||
| SSI - Colon Surgery: Number of Procedures2024-10-01 to 2025-09-30 | 6 | 61 | 115 | ||
| SSI - Colon Surgery: Predicted Cases2024-10-01 to 2025-09-30 | 0.181 | 1.591 | 3.302 | ||
| SSI - Colon Surgery: Observed Cases2024-10-01 to 2025-09-30 | 0 | 1 | 2.222 | ||
| SSI - Colon Surgery2024-10-01 to 2025-09-30 | Not Available | 0.6198 | |||
| SSI - Abdominal Hysterectomy: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.3223 | |||
| SSI - Abdominal Hysterectomy: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.058 | |||
| SSI - Abdominal Hysterectomy: Number of Procedures2024-10-01 to 2025-09-30 | 13 | 38 | 169 | ||
| SSI - Abdominal Hysterectomy: Predicted Cases2024-10-01 to 2025-09-30 | 0.114 | 0.328 | 1.547 | ||
| SSI - Abdominal Hysterectomy: Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 1.1 | ||
| SSI - Abdominal Hysterectomy2024-10-01 to 2025-09-30 | Not Available | 0.6612 | |||
| MRSA Bacteremia: Lower Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 0.3413 | |||
| MRSA Bacteremia: Upper Confidence Limit2024-10-01 to 2025-09-30 | Not Available | 2.26 | |||
| MRSA Bacteremia: Patient Days2024-10-01 to 2025-09-30 | 7,948 | 14,451 | 38,119 | ||
| MRSA Bacteremia: Predicted Cases2024-10-01 to 2025-09-30 | 0.308 | 0.567 | 2.905 | ||
| MRSA Bacteremia: Observed Cases2024-10-01 to 2025-09-30 | 0 | 0 | 2.295 | ||
| MRSA Bacteremia2024-10-01 to 2025-09-30 | Not Available | 0.8121 | |||
| Clostridium Difficile (C.Diff): Lower Confidence Limit2024-10-01 to 2025-09-30 | 0.013 | 0.127 | 0.2104 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Upper Confidence Limit2024-10-01 to 2025-09-30 | 1.275 | 0.747 | 1.307 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Patient Days2024-10-01 to 2025-09-30 | 7,336 | 13,646 | 35,794 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Predicted Cases2024-10-01 to 2025-09-30 | 3.869 | 5.683 | 20 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff): Observed Cases2024-10-01 to 2025-09-30 | 1 | 2 | 8.833 | No Different than National Benchmark | |
| Clostridium Difficile (C.Diff)2024-10-01 to 2025-09-30 | 0.258 | 0.279 | 0.3683 | No Different than National Benchmark | Better than 53% of US hospitals |
How recent inpatients answered each survey question, with CMS's star rating per topic.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Room was "always" clean2024-10-01 to 2025-09-30 · 221 cases | 77 | 73 | 70.64 | Better than 64% of US hospitals | |
| Room was "sometimes" or "never" clean2024-10-01 to 2025-09-30 · 221 cases | 6 | 8 | 10.56 | Better than 65% of US hospitals | |
| Room was "usually" clean2024-10-01 to 2025-09-30 · 221 cases | 17 | 18 | 18.79 | ||
| Cleanliness - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 90 | 87 | 83.69 | Better than 74% of US hospitals | |
| Cleanliness - star rating2024-10-01 to 2025-09-30 · 221 cases | 4 | 4 | 2.759 | Better than 47% of US hospitals | |
| Nurses "always" communicated well2024-10-01 to 2025-09-30 · 221 cases | 82 | 80 | 79.88 | Better than 63% of US hospitals | |
| Nurse communication - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 93 | 91 | 91.09 | Better than 69% of US hospitals | |
| Nurses "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 221 cases | 3 | 4 | 4.699 | Better than 58% of US hospitals | |
| Nurse communication - star rating2024-10-01 to 2025-09-30 · 221 cases | 4 | 3 | 3.315 | Better than 51% of US hospitals | |
| Nurses "usually" communicated well2024-10-01 to 2025-09-30 · 221 cases | 15 | 16 | 15.42 | ||
| Doctors "always" communicated well2024-10-01 to 2025-09-30 · 221 cases | 83 | 79 | 81.51 | Better than 71% of US hospitals | |
| Doctor communication - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 93 | 91 | 91.22 | Better than 77% of US hospitals | |
| Doctors "sometimes" or "never" communicated well2024-10-01 to 2025-09-30 · 221 cases | 5 | 5 | 5.027 | Better than 44% of US hospitals | |
| Doctor communication - star rating2024-10-01 to 2025-09-30 · 221 cases | 4 | 3 | 3.278 | Better than 63% of US hospitals | |
| Doctors "usually" communicated well2024-10-01 to 2025-09-30 · 221 cases | 12 | 16 | 13.47 | ||
| Staff "always" explained2024-10-01 to 2025-09-30 · 221 cases | 69 | 61 | 62.21 | Better than 81% of US hospitals | |
| Communication about medicines - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 83 | 77 | 77.09 | Better than 88% of US hospitals | |
| Staff "sometimes" or "never" explained2024-10-01 to 2025-09-30 · 221 cases | 13 | 19 | 19.6 | Better than 83% of US hospitals | |
| Communication about medicines - star rating2024-10-01 to 2025-09-30 · 221 cases | 4 | 3 | 2.685 | Better than 79% of US hospitals | |
| Staff "usually" explained2024-10-01 to 2025-09-30 · 221 cases | 18 | 19 | 18.19 | ||
| Discharge information - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 83 | 86 | 84.46 | Worse than 74% of US hospitals | |
| No, staff "did not" give patients this information2024-10-01 to 2025-09-30 · 221 cases | 16 | 13 | 14.63 | Worse than 72% of US hospitals | |
| Discharge information - star rating2024-10-01 to 2025-09-30 · 221 cases | 3 | 3 | 3.056 | Worse than 45% of US hospitals | |
| Yes, staff "did" give patients this information2024-10-01 to 2025-09-30 · 221 cases | 84 | 87 | 85.37 | Worse than 72% of US hospitals | |
| No, staff "did not" give patients information about help after discharge2024-10-01 to 2025-09-30 · 221 cases | 15 | 14 | 16.42 | Worse than 51% of US hospitals | |
| Yes, staff "did" give patients information about help after discharge2024-10-01 to 2025-09-30 · 221 cases | 85 | 86 | 83.58 | Worse than 51% of US hospitals | |
| Doctors "always" explained things so they could understand2024-10-01 to 2025-09-30 · 221 cases | 80 | 74 | 76.38 | Better than 82% of US hospitals | |
| Doctors "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 221 cases | 5 | 7 | 6.297 | Better than 68% of US hospitals | |
| Doctors "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 221 cases | 15 | 19 | 17.33 | ||
| Doctors "always" listened carefully2024-10-01 to 2025-09-30 · 221 cases | 83 | 77 | 79.28 | Better than 81% of US hospitals | |
| Doctors "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 221 cases | 5 | 6 | 5.516 | Better than 53% of US hospitals | |
| Doctors "usually" listened carefully2024-10-01 to 2025-09-30 · 221 cases | 12 | 17 | 15.2 | ||
| Doctors "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 221 cases | 87 | 85 | 86.14 | Better than 62% of US hospitals | |
| Doctors "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 221 cases | 4 | 3 | 3.688 | Worse than 51% of US hospitals | |
| Doctors "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 221 cases | 9 | 11 | 10.17 | ||
| Patients who gave a rating of "6" or lower (low)2024-10-01 to 2025-09-30 · 221 cases | 8 | 8 | 8.753 | Worse than 48% of US hospitals | |
| Patients who gave a rating of "7" or "8" (medium)2024-10-01 to 2025-09-30 · 221 cases | 21 | 20 | 20.79 | ||
| Patients who gave a rating of "9" or "10" (high)2024-10-01 to 2025-09-30 · 221 cases | 71 | 72 | 70.45 | Worse than 51% of US hospitals | |
| Overall hospital rating - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 88 | 88 | 87.57 | Worse than 45% of US hospitals | |
| Overall hospital rating - star rating2024-10-01 to 2025-09-30 · 221 cases | 3 | 3 | 3.222 | Worse than 45% of US hospitals | |
| Staff "always" explained new medications2024-10-01 to 2025-09-30 · 221 cases | 82 | 74 | 74.89 | Better than 87% of US hospitals | |
| Staff "sometimes" or "never" explained new medications2024-10-01 to 2025-09-30 · 221 cases | 7 | 9 | 9.938 | Better than 71% of US hospitals | |
| Staff "usually" explained new medications2024-10-01 to 2025-09-30 · 221 cases | 11 | 16 | 15.17 | ||
| Nurses "always" explained things so they could understand2024-10-01 to 2025-09-30 · 221 cases | 76 | 75 | 75.05 | Better than 55% of US hospitals | |
| Nurses "sometimes" or "never" explained things so they could understand2024-10-01 to 2025-09-30 · 221 cases | 3 | 5 | 6 | Better than 81% of US hospitals | |
| Nurses "usually" explained things so they could understand2024-10-01 to 2025-09-30 · 221 cases | 21 | 20 | 18.95 | ||
| Nurses "always" listened carefully2024-10-01 to 2025-09-30 · 221 cases | 83 | 77 | 76.77 | Better than 82% of US hospitals | |
| Nurses "sometimes" or "never" listened carefully2024-10-01 to 2025-09-30 · 221 cases | 3 | 4 | 5.703 | Better than 64% of US hospitals | |
| Nurses "usually" listened carefully2024-10-01 to 2025-09-30 · 221 cases | 14 | 19 | 17.53 | ||
| Nurses "always" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 221 cases | 87 | 86 | 84.83 | Better than 53% of US hospitals | |
| Nurses "sometimes" or "never" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 221 cases | 2 | 3 | 3.531 | Better than 50% of US hospitals | |
| Nurses "usually" treated them with courtesy and respect2024-10-01 to 2025-09-30 · 221 cases | 11 | 11 | 11.64 | ||
| "Always" quiet at night2024-10-01 to 2025-09-30 · 221 cases | 69 | 59 | 66.56 | Better than 80% of US hospitals | |
| "Sometimes" or "never" quiet at night2024-10-01 to 2025-09-30 · 221 cases | 8 | 9 | 6.575 | Better than 53% of US hospitals | |
| "Usually" quiet at night2024-10-01 to 2025-09-30 · 221 cases | 23 | 31 | 26.86 | ||
| Quietness - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 87 | 82 | 84.96 | Better than 85% of US hospitals | |
| Quietness - star rating2024-10-01 to 2025-09-30 · 221 cases | 4 | 3 | 4 | Better than 56% of US hospitals | |
| "NO", patients would not recommend the hospital (they probably would not or definitely would not recommend it)2024-10-01 to 2025-09-30 · 221 cases | 6 | 5 | 6.466 | Worse than 55% of US hospitals | |
| "YES", patients would definitely recommend the hospital2024-10-01 to 2025-09-30 · 221 cases | 62 | 71 | 70.55 | Worse than 81% of US hospitals | |
| Recommend hospital - linear mean score2024-10-01 to 2025-09-30 · 221 cases | 85 | 87 | 86.26 | Worse than 67% of US hospitals | |
| "YES", patients would probably recommend the hospital2024-10-01 to 2025-09-30 · 221 cases | 32 | 23 | 22.99 | ||
| Recommend hospital - star rating2024-10-01 to 2025-09-30 · 221 cases | 3 | 4 | 3.389 | Worse than 58% of US hospitals | |
| Staff "always" explained possible side effects2024-10-01 to 2025-09-30 · 221 cases | 56 | 47 | 48.08 | Better than 83% of US hospitals | |
| Staff "sometimes" or "never" explained possible side effects2024-10-01 to 2025-09-30 · 221 cases | 19 | 30 | 30.03 | Better than 90% of US hospitals | |
| Staff "usually" explained possible side effects2024-10-01 to 2025-09-30 · 221 cases | 25 | 22 | 21.89 | ||
| Summary star rating2024-10-01 to 2025-09-30 · 221 cases | 4 | 3 | 3.241 | Better than 60% of US hospitals | |
| No, staff "did not" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 221 cases | 16 | 12 | 13 | Worse than 81% of US hospitals | |
| Yes, staff "did" give patients information about possible symptoms2024-10-01 to 2025-09-30 · 221 cases | 84 | 88 | 87 | Worse than 81% of US hospitals |
How often the hospital gave recommended care, and how fast.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Emergency department volume2024-01-01 to 2024-12-31 | low | ||||
| Global Malnutrition Composite Score2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Malnutrition Diagnosis Documented2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Malnutrition Risk Screening2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Nutrition Assessment2024-01-01 to 2024-12-31 | Not Available | ||||
| Global Malnutrition Composite Score: Nutritional Care Plan2024-01-01 to 2024-12-31 | Not Available | ||||
| Hospital Harm - Severe Hyperglycemia2024-01-01 to 2024-12-31 | Not Available | 10 | |||
| Hospital Harm - Severe Hypoglycemia2024-01-01 to 2024-12-31 | Not Available | 1.7 | |||
| Hospital Harm - Opioid Related Adverse Events2024-01-01 to 2024-12-31 | Not Available | 0.5 | |||
| Healthcare workers given influenza vaccination2024-10-01 to 2025-03-31 · 840 cases | 72 | 79 | 62.92 | Worse than 61% of US hospitals | |
| Average (median) time all patients spent in the emergency department before leaving from the visit, including psychiatric/mental health patients and patients who were transferred to another facility. A lower number of minutes is better2024-10-01 to 2025-09-30 · 788 cases | 184 | 154 | 158 | Worse than 69% of US hospitals | |
| Average (median) time patients spent in the emergency department before leaving from the visit, excluding patients transferred to another facility or psychiatric care/mental health patients. A lower number of minutes is better2024-10-01 to 2025-09-30 · 727 cases | 176 | 148 | 153 | Worse than 68% of US hospitals | |
| Average (median) time psychiatric/mental health patients spent in the emergency department before leaving from the visit. A lower number of minutes is better2024-10-01 to 2025-09-30 · 30 cases | 318 | 247 | 255 | Worse than 73% of US hospitals | |
| Average (median) time patients spent in the emergency department before being transferred to another facility. A lower number of minutes is better2024-10-01 to 2025-09-30 · 36 cases | 337 | 293 | 311 | Worse than 67% of US hospitals | |
| Left before being seen2024-01-01 to 2024-12-31 · 18,118 cases | 3 | 1 | 2.342 | Worse than 78% of US hospitals | |
| Head CT results2024-10-01 to 2025-09-30 · 12 cases | 17 | 74 | 67.37 | Worse than 98% of US hospitals | |
| Endoscopy/polyp surveillance: appropriate follow-up interval for normal colonoscopy in average risk patients2024-01-01 to 2024-12-31 · 64 cases | 83 | 97 | 90.8 | Worse than 88% of US hospitals | |
| Improvement in Patient's Visual Function within 90 Days Following Cataract Surgery2024-01-01 to 2024-12-31 | Not Available | 100 | |||
| ST-Segment Elevation Myocardial Infarction (STEMI)2024-01-01 to 2024-12-31 | Not Available | 46.43 | |||
| Safe Use of Opioids - Concurrent Prescribing2024-01-01 to 2024-12-31 · 574 cases | 17 | 15 | 14.5 | Worse than 66% of US hospitals | |
| Appropriate care for severe sepsis and septic shock2024-10-01 to 2025-09-30 · 130 cases | 42 | 65 | 62.47 | Worse than 90% of US hospitals | |
| Septic Shock 3-Hour Bundle2024-10-01 to 2025-09-30 · 20 cases | 60 | 73 | 70.8 | Worse than 76% of US hospitals | |
| Septic Shock 6-Hour Bundle2024-10-01 to 2025-09-30 · 11 cases | 55 | 88 | 87.48 | Worse than 96% of US hospitals | |
| Severe Sepsis 3-Hour Bundle2024-10-01 to 2025-09-30 · 130 cases | 62 | 82 | 79.9 | Worse than 95% of US hospitals | |
| Severe Sepsis 6-Hour Bundle2024-10-01 to 2025-09-30 · 63 cases | 79 | 94 | 90.95 | Worse than 93% of US hospitals | |
| Discharged on Antithrombotic Therapy2024-01-01 to 2024-12-31 · 38 cases | 92 | 98 | 95.75 | Worse than 89% of US hospitals | |
| Anticoagulation Therapy for Atrial Fibrillation/Flutter2024-01-01 to 2024-12-31 | Not Available | 77.67 | |||
| Antithrombotic Therapy by End of Hospital Day 22024-01-01 to 2024-12-31 · 38 cases | 95 | 94 | 91.83 | Better than 54% of US hospitals | |
| Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 | Not Available | 75.44 | |||
| Intensive Care Unit Venous Thromboembolism Prophylaxis2024-01-01 to 2024-12-31 · 384 cases | 65 | 97 | 89.85 | Worse than 97% of US hospitals |
How often scans were ordered when they may not be needed; lower is better.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Abdomen CT Use of Contrast Material2024-07-01 to 2025-06-30 | 11.1 | 5 | 7.666 | Worse than 90% of US hospitals | |
| Breast Cancer Screening Recall Rates2024-07-01 to 2025-06-30 | Not Available | 6.484 |
Medicare spending around an inpatient stay compared with the US (1 is the US median).
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| Medicare hospital spending per patient (Medicare Spending per Beneficiary)2024-01-01 to 2024-12-31 | 0.94 | 0.99 | 0.9828 | Better than 73% of US hospitals |
The scores Medicare uses to raise or lower inpatient payments; higher is better.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| VBP clinical outcomes domain scoreFY 2026 | 0 | 20 | 12.82 | The worst result, shared by 11% of US hospitals | |
| VBP clinical outcomes weighted domain scoreFY 2026 | 0 | 5 | 3.268 | The worst result, shared by 11% of US hospitals | |
| VBP efficiency and cost reduction domain scoreFY 2026 | 50 | 10 | 19.17 | Better than 84% of US hospitals | |
| VBP efficiency and cost reduction weighted domain scoreFY 2026 | 12.5 | 2.5 | 5.035 | Better than 83% of US hospitals | |
| VBP person and community engagement domain scoreFY 2026 | 54 | 34 | 41.4 | Better than 80% of US hospitals | |
| VBP person and community engagement weighted domain scoreFY 2026 | 13.5 | 8.75 | 10.89 | Better than 79% of US hospitals | |
| VBP safety domain scoreFY 2026 | 50 | 40 | 40.62 | Better than 64% of US hospitals | |
| VBP safety weighted domain scoreFY 2026 | 12.5 | 10 | 10.27 | Better than 64% of US hospitals | |
| VBP total performance scoreFY 2026 | 38.5 | 29.5 | 28.52 | Better than 77% of US hospitals |
| By fiscal year | FY 2021 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|
| VBP clinical outcomes domain score | 32.5 | 0 | 3.333 | 0 | 0 |
| VBP clinical outcomes weighted domain score | 10.83 | 0 | 0.8333 | 0 | 0 |
| VBP efficiency and cost reduction domain score | 0 | 40 | 40 | 0 | 50 |
| VBP efficiency and cost reduction weighted domain score | 0 | 10 | 10 | 0 | 12.5 |
| VBP person and community engagement domain score | 31 | Not Available | 15 | 26 | 54 |
| VBP person and community engagement weighted domain score | 10.33 | Not Available | 3.75 | 6.5 | 13.5 |
| VBP safety domain score | Not Available | Not Available | 20 | 50 | 50 |
| VBP safety weighted domain score | Not Available | Not Available | 5 | 12.5 | 12.5 |
| VBP total performance score | 21.17 | Not Available | 19.58 | 19 | 38.5 |
Excess readmission ratios by condition; above 1 means more readmissions than expected.
| Measure | Highlands Medical Center | 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 | 1.012 | 0.9969 | 0.996 | Worse than 63% of US hospitals | |
| READM-30-HF-HRRP2021-07-01 to 2024-06-30 | 0.9478 | 0.9983 | 1.009 | Better than 81% of US hospitals | |
| 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 · 124 cases | 0.9641 | 0.9955 | 1.003 | Better than 72% 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 | 0.9465 | 0.9461 | 0.9961 | 1.016 | 0.998 | 1.012 |
| READM-30-HF-HRRP | 0.9121 | 0.9636 | 0.9467 | 0.9518 | 0.9393 | 0.9478 |
| READM-30-HIP-KNEE-HRRP | 1.201 | 1.038 | 1.119 | N/A | N/A | N/A |
| READM-30-PN-HRRP | 0.982 | 0.9999 | 1.017 | 0.9879 | 0.9658 | 0.9641 |
Infection ratios, the PSI 90 composite and the total score Medicare ranks hospitals on; lower is better.
| Measure | Highlands Medical Center | US median | AL average | CMS comparison | US rank |
|---|---|---|---|---|---|
| CAUTI standardized infection ratio2023-01-01 to 2024-12-31 | 1.042 | 0.489 | 0.5999 | Worse than 87% of US hospitals | |
| CDI standardized infection ratio2023-01-01 to 2024-12-31 | 0.494 | 0.346 | 0.4007 | Worse than 71% of US hospitals | |
| CLABSI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.8784 | |||
| HAC Reduction Program payment reductionFY 2026 | Yes | ||||
| 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 | 1.002 | 0.9628 | 1.049 | Worse than 66% of US hospitals | |
| SSI standardized infection ratio2023-01-01 to 2024-12-31 | N/A | 0.5688 | |||
| Total HAC scoreFY 2026 | 0.5781 | -0.0453 | 0.09962 | Worse than 83% of US hospitals |
| By fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| HAC Reduction Program payment reduction | Yes | No | N/A | Yes | Yes | Yes |
| Total HAC score | 0.8377 | -0.6751 | 0 | 0.6982 | 0.9465 | 0.5781 |
Source: CMS Care Compare hospital files, latest release 2026-09-30, 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.
ACHC (since 2003)
Accreditation
None
Medical school affiliation
Hospital district or authority
Ownership type
170
Medicare-certified beds
119
Registered nurses (full-time equivalent)
1966
In Medicare since
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What Highlands Medical Center reported to Medicare in its latest cost report, covering Nov 1, 2024 to Oct 31, 2025.
2,173
Inpatient discharges
Medicare 22%, Medicaid 21%
7,040
Inpatient days
43% of available bed days used
356
Employees (full-time equivalent)
Source: CMS cost report (HCRIS) (report 832152). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges Highlands Medical Center reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 1,715 | 1,587 | 3,738 | 7,040 |
| Discharges | 484 | 464 | 1,225 | 2,173 |
| Average length of stay | 3.5 days | 3.4 days | 3.1 days | 3.2 days |
| Average daily census | 4.7 | 4.3 | 10.2 | 19.3 |
1,023
Medicare Advantage days
273 discharges
1,242
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 35 | 4,539 | 1,326 | 36% |
| Intensive care unit | 10 | 1,895 | 389 | 52% |
| Nursery | 606 | |||
| Skilled nursing facility | 50 | 16,299 | 4,078 | 89% |
Source: CMS cost report (HCRIS, Form 2552-10), report 832152, as submitted. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
What Highlands Medical Center treats Medicare patients for most often, in 2024. 198 Medicare discharges in 10 published DRGs; 7% surgical; 70% in DRGs with complications (CC or MCC).
| Condition or procedure | Discharges | Average charges | Average Medicare payment | Estimated cost | DRG weight |
|---|---|---|---|---|---|
| Septicemia or severe sepsis without MV >96 hours with MCCMS-DRG 871, medical | 35 | $29,302 | $12,696 | $12,952 | 1.98 |
| Kidney and urinary tract infections without MCCMS-DRG 690, medical | 29 | $14,224 | $5,250 | $6,287 | 0.81 |
| Respiratory infections and inflammations with MCCMS-DRG 177, medical | 22 | $26,366 | $10,439 | $11,654 | 1.70 |
| Kidney and urinary tract infections with MCCMS-DRG 689, medical | 21 | $17,159 | $7,844 | $7,584 | 1.17 |
| Simple pneumonia and pleurisy with MCCMS-DRG 193, medical | 20 | $18,252 | $8,547 | $8,067 | 1.33 |
| Esophagitis, gastroenteritis and miscellaneous digestive disorders without MCCMS-DRG 392, medical | 18 | $13,867 | $5,391 | $6,129 | 0.79 |
| Heart failure and shock with MCCMS-DRG 291, medical | 17 | $20,355 | $8,714 | $8,997 | 1.28 |
| Hip replacement with principal diagnosis of hip fracture without MCCMS-DRG 522, surgical | 13 | $46,849 | $14,430 | $20,707 | 2.11 |
| Renal failure with CCMS-DRG 683, medical | 12 | $12,799 | $6,145 | $5,657 | 0.90 |
| Simple pneumonia and pleurisy with CCMS-DRG 194, medical | 11 | $18,303 | $5,512 | $8,090 | 0.82 |
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) Highlands Medical Center billed Medicare for most in 2024: 293 services in all.
| Service group | Services | Patients | Average charges | Average Medicare payment | US average payment |
|---|---|---|---|---|---|
| Comprehensive Observation ServicesAPC 8011 | 110 | 101 | $9,610 | $1,929 | $2,090 |
| Level 1 Intraocular ProceduresAPC 5491 | 32 | 19 | $6,275 | $1,700 | $1,752 |
| Level 1 Nerve ProceduresAPC 5431 | 27 | 22 | $7,945 | $1,402 | $1,407 |
| Level 4 Urology and Related ServicesAPC 5374 | 23 | 19 | $18,196 | $2,529 | $2,629 |
| Level 2 Excision/ Biopsy/ Incision and DrainageAPC 5072 | 18 | 18 | $9,334 | $1,174 | $1,220 |
| Level 4 Musculoskeletal ProceduresAPC 5114 | 18 | 18 | $23,441 | $4,925 | $5,339 |
| Level 5 Urology and Related ServicesAPC 5375 | 17 | 16 | $19,363 | $3,775 | $3,918 |
| Level 2 Upper GI ProceduresAPC 5302 | 14 | 14 | $6,273 | $1,384 | $1,445 |
| Level 2 Vascular ProceduresAPC 5182 | 12 | 12 | $6,230 | $1,055 | $1,204 |
| Level 2 Musculoskeletal ProceduresAPC 5112 | 11 | 11 | $6,534 | $1,173 | $1,196 |
See all 11 Medicare outpatient services at Highlands Medical Center
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.
ZIP codes with the most Medicare inpatient stays at Highlands Medical Center in 2025. Market share is this hospital's part of every hospital's Medicare stays from the ZIP code. Its published Medicare stays went from 865 in 2020 to 623 in 2025.
| ZIP code | Stays | Of this hospital's stays | Days | Charges | Market share | Share in 2020 |
|---|---|---|---|---|---|---|
| 35768 | 186 | 30% | 621 | $3.7M | 34% | 41% |
| 35769 | 121 | 19% | 438 | $2.5M | 25% | 35% |
| 35744 | 47 | 8% | 169 | $996,915 | 55% | 41% |
| 35772 | 45 | 7% | 185 | $1.1M | 20% | 32% |
| 35771 | 43 | 7% | 171 | $970,726 | 30% | 37% |
| 35752 | 26 | 4% | 91 | $636,870 | 36% | 46% |
| 35776 | 25 | 4% | 87 | $492,983 | 18% | 18% |
| 35765 | 23 | 4% | 65 | $449,609 | 20% | 26% |
| 35978 | 22 | 4% | 76 | $477,980 | 11% | 8% |
| 35740 | 17 | 3% | 58 | $341,255 | 10% | 21% |
| 35986 | 17 | 3% | 59 | $373,440 | 4% | 4% |
| 35747 | 14 | 2% | 64 | $358,309 | 5% | |
| 35966 | 14 | 2% | 44 | $306,788 | 7% | |
| 35971 | 12 | 2% | 46 | $278,993 | 8% | 16% |
| 35755 | 11 | 2% | 36 | $210,058 | 34% |
Source: CMS Hospital Service Area file. Shares are of the 623 stays from ZIP codes CMS publishes; it omits ZIP codes with fewer than 11 stays, so market shares count published stays only.
Staff by profession and the rooms and units Highlands Medical Center reported at its latest Medicare certification survey (2012). Counts are people, not full-time equivalents.
5
Operating rooms
2
Endoscopy rooms
119
Registered nurses
14
Licensed practical nurses
2
Physicians
1
Nurse practitioners
3
Pharmacists
9
Respiratory therapists
1
Physical therapists
1
Speech pathologists and audiologists
26
Radiology technicians
2
Nuclear medicine technicians
3
Laboratory technicians
8
Medical technologists
1
Social workers
461
Other personnel
Source: CMS Provider of Services file.
262 clinicians who bill Medicare list Highlands Medical Center as a hospital affiliation. Showing 24 of them. Book a demo to see the commercial rates insurers publish for them, or start a free trial.
Rosa Michel Ortega, M.D.
Hematology & Oncology Physician
NPI 1942513320
See commercial rates for Rosa Michel Ortega, M.D.Daniel Schreeder, MD, PHD
Hematology & Oncology Physician
NPI 1457650848
See commercial rates for Daniel Schreeder, MD, PHDSurrinder Dang, M.D.
Hematology & Oncology Physician
NPI 1699755116
See commercial rates for Surrinder Dang, M.D.John Nicholson, M.D.
Hematology & Oncology Physician
NPI 1548550833
See commercial rates for John Nicholson, M.D.Benjamin Miriovsky, M.D.
Hematology & Oncology Physician
NPI 1427234277
See commercial rates for Benjamin Miriovsky, M.D.David White
Neurology Physician
NPI 1871882357
See commercial rates for David WhiteRoxanna Sabghi, M.D.
Rheumatology Physician
NPI 1073990933
See commercial rates for Roxanna Sabghi, M.D.Ayesha Jaleel, M.D.
Rheumatology Physician
NPI 1093194714
See commercial rates for Ayesha Jaleel, M.D.Eric Janssen, M.D.
Sports Medicine (Orthopaedic Surgery) Physician
NPI 1831145978
See commercial rates for Eric Janssen, M.D.Kevin Waldrop, M.D.
Diagnostic Radiology Physician
NPI 1306870746
See commercial rates for Kevin Waldrop, M.D.Timothy Baker, M.D.
Diagnostic Radiology Physician
NPI 1356324586
See commercial rates for Timothy Baker, M.D.Scott Parker, MD
Infectious Disease Physician
NPI 1992716120
See commercial rates for Scott Parker, MDRoderick Zalamea, M.D.
Diagnostic Radiology Physician
NPI 1669505368
See commercial rates for Roderick Zalamea, M.D.Bradley Wills
Orthopaedic Surgery Physician
NPI 1427477686
See commercial rates for Bradley WillsJohn Mccarty, DO
Diagnostic Radiology Physician
NPI 1063776532
See commercial rates for John Mccarty, DOJosephine Ndolo, MBCHB
Diagnostic Radiology Physician
NPI 1346690187
See commercial rates for Josephine Ndolo, MBCHBMichael Brooks, MD
Diagnostic Radiology Physician
NPI 1184087975
See commercial rates for Michael Brooks, MDCarter Pelham, MD
Diagnostic Radiology Physician
NPI 1225473325
See commercial rates for Carter Pelham, MDAaron Coleman, MD
Diagnostic Radiology Physician
NPI 1073960241
See commercial rates for Aaron Coleman, MDDouglas Sutherland, M.D.
Diagnostic Radiology Physician
NPI 1851374607
See commercial rates for Douglas Sutherland, M.D.Michael Smith, M.D.
Diagnostic Radiology Physician
NPI 1306829155
See commercial rates for Michael Smith, M.D.Eric Poulos, M.D.
Diagnostic Radiology Physician
NPI 1104270420
See commercial rates for Eric Poulos, M.D.Sudhakar Madanagopal, MD
Orthopaedic Trauma Physician
NPI 1033163308
See commercial rates for Sudhakar Madanagopal, MDJoseph Scales, M.D.
Diagnostic Radiology Physician
NPI 1952367120
See commercial rates for Joseph Scales, M.D.Source: CMS Doctors and Clinicians facility affiliations, released 2026-10-15, with names and specialties from NPPES. Affiliation means the clinician bills Medicare for care at this hospital; it is not employment.
Revenue, expenses and income Highlands Medical Center reported to Medicare for Nov 1, 2024 to Oct 31, 2025. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $175.6M | 427.9% |
| Inpatient | $46.8M | 114.0% |
| Outpatient | $128.8M | 313.9% |
| Contractual allowances and discounts | -$134.5M | -327.9% |
| Net patient revenue | $41M | 100.0% |
| Operating expenses | -$66.5M | -162.1% |
| Operating income from patient care | -$25.5M | -62.1% |
| Other income | $6.3M | 15.3% |
| Investment income | $37,709 | 0.1% |
| Government appropriations | $5.2M | 12.6% |
| Other | $1.1M | 2.6% |
| Net income | -$19.2M | -46.8% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $25.3M | 14.4% |
| Medicaid (including managed care) | $19.2M | 10.9% |
| Other payers and self-pay | $131.1M | 74.6% |
| Total charges | $175.7M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 832152, 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 Highlands Medical Center's latest cost report.
-62.1%
Operating margin
Operating income from patient care / net patient revenue
-40.6%
Total margin
Net income / net patient revenue plus other income
-34.0%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
49% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$31.05
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
8.4 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 832152, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
What Highlands Medical Center owned and owed at the end of its reporting period (Oct 2025), across all fund types: $36.3M in total assets and a -$14.1M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | $2.2M | 6.1% |
| Patient receivables, net | $6.6M | 18.3% |
| Inventory | $1.7M | 4.8% |
| Total current assets | $13M | 35.7% |
| Property and equipment, net of depreciation | $20.2M | 55.6% |
| Investments and other assets | $3.2M | 8.7% |
| Total assets | $36.3M | 100.0% |
| Current liabilities | $44.9M | 123.6% |
| Long-term debt | $430,694 | 1.2% |
| Total liabilities | $45.4M | 124.8% |
| Fund balance (net assets) | -$14.1M | -38.8% |
Source: CMS cost report (HCRIS, Form 2552-10), report 832152, as submitted. Hospitals report these figures themselves; they are not audited financial statements. This report's assets do not equal its liabilities plus fund balance, so ratios based on it are not shown.
Care Highlands Medical Center provided without full payment, as reported on Worksheet S-10 of its cost report.
$790,780
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$9.5M
Bad debt
Patient bills written off as uncollectible, at charges
$4.9M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$4.4M
Total unreimbursed and uncompensated care
6.6% 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 832152, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Highlands Medical Center's full-year cost reports, by fiscal year end. Reports shorter than ten months are left out.
| Fiscal year ending | Sep 2020 | Sep 2021 | Oct 2022 | Oct 2023 | Oct 2024 | Oct 2025 |
|---|---|---|---|---|---|---|
| Net patient revenue | $38.2M | $41.2M | $45.9M | $53.2M | $50.9M | $41M |
| Operating expenses | $47.1M | $51.2M | $59.8M | $62.2M | $67.1M | $66.5M |
| Operating margin | -23.3% | -24.4% | -30.2% | -16.9% | -31.9% | -62.1% |
| Net income | -$817,936 | $1.2M | -$1.8M | -$6.4M | -$14.5M | -$19.2M |
| Total assets | $54.9M | $39.3M | $50.3M | $37.4M | $36M | $36.3M |
| Discharges | 2,138 | 2,041 | 2,278 | 2,055 | 2,090 | 2,173 |
| Inpatient days | 8,990 | 9,827 | 9,686 | 7,803 | 7,287 | 7,040 |
| Medicare Advantage days | 1,234 | 1,645 | 1,670 | 1,814 | 2,021 | 1,023 |
| Beds | 95 | 95 | 95 | 95 | 95 | 95 |
| Employees (FTE) | 354 | 431 | 390 | 403 | 441 | 356 |
Source: CMS cost report (HCRIS, Form 2552-10), report 832152, as submitted. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center Highlands Medical Center 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 |
|---|---|---|---|---|---|
| Operating room | $2.3M | $6.8M | $19.1M | 0.36 | 24,227 |
| Medical supplies charged to patient | $5.4M | $12.7M | 0.43 | ||
| Emergency | $1.8M | $5.3M | $14.2M | 0.37 | 15,896 |
| Radiology-diagnostic | $1.7M | $4.9M | $47.9M | 0.10 | 11,311 |
| Drugs charged to patients | $3.7M | $11.1M | 0.33 | ||
| Laboratory | $1M | $3.5M | $19.3M | 0.18 | 4,001 |
| Home health agency | $1.8M | $2.9M | 0.63 | ||
| Respiratory therapy | $637,073 | $1.8M | $4.7M | 0.37 | 10,754 |
| Physical therapy | $422,065 | $1.3M | $1.7M | 0.77 | 9,522 |
| Observation beds (non-distinct part | $1.3M | $2.8M | 0.46 | ||
| Wound care | $235,311 | $1.2M | $4M | 0.30 | 2,688 |
| Delivery room & labor room | $425,647 | $1.2M | $1.4M | 0.83 | 5,562 |
| Impl. dev. charged to patients | $943,977 | $1.2M | 0.81 | ||
| Rural health clinic ii | $479,612 | $846,555 | $917,466 | 0.92 | 2,638 |
| Rural health clinic | $352,130 | $698,880 | $996,765 | 0.70 | 2,247 |
| Sleep lab | $300,350 | $589,654 | $2.4M | 0.24 | 2,151 |
| Clinic | $434,159 | $308,055 | $383,392 | 0.80 | 400 |
| Occupational therapy | $178,963 | $294,436 | $826,628 | 0.36 | 336 |
| Anesthesiology | $10 | $248,979 | $11.1M | 0.02 | |
| Hyperbaric oxygen therapy | $150,858 | $225,000 | 0.67 | 350 | |
| Speech pathology | $74,929 | $110,429 | $296,836 | 0.37 | 140 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Skilled nursing facility | $2.8M | $6.3M | $6.7M | 0.94 | |
| Adults & pediatrics | $2.3M | $5.9M | $5.3M | 1.10 | 13,185 |
| Intensive care unit | $1.5M | $3.2M | $2.9M | 1.13 | 5,893 |
| Nursery | $493,333 | $611,824 | 0.81 | 864 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Administrative & general | $1.9M | $9.1M | 98,944 | $18.73 | |
| Operation of plant | $1.1M | $4.2M | 33,945 | $32.23 | |
| Medical records & library | $722,311 | $2M | 25,617 | $28.20 | 1,871 |
| Employee benefits department | $95,648 | $1.9M | 2,159 | $44.31 | |
| Cap rel costs-mvble equip | $1.9M | ||||
| Cap rel costs-bldg & fixt | $1.2M | 136,071 | |||
| Pharmacy | $694,323 | $1.1M | 14,508 | $47.86 | 1,066 |
| Housekeeping | $761,566 | $1M | 46,055 | $15.23 | 380 |
| Dietary | $681,921 | $826,143 | 37,925 | $17.98 | 5,977 |
| Nursing administration | $515,090 | $770,037 | 12,101 | $42.57 | 2,604 |
| Laundry & linen service | $337,738 | 4,160 | $14.44 | 442 |
Source: CMS cost report (HCRIS, Form 2552-10), report 832152, 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.
The factors Medicare uses to set what it pays Highlands Medical Center for an inpatient stay.
1.34
Case mix index
Higher than 13% of hospitals paid under Medicare IPPS
Average Medicare DRG weight of its inpatient cases (FY 2027); higher means more complex, costlier care.
No Medicare-funded residents
Teaching status
Medicare-funded interns and residents per bed (FY 2027).
25.8%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2027).
478
Medicare inpatient stays
Medicare claims CMS based FY 2027 payment rates on.
Rural
Location type
Geographic area CMS assigns before any wage index reclassification (FY 2027).
| IPPS fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 | FY 2027 |
|---|---|---|---|---|---|---|---|
| Case mix index | 1.19 | 1.19 | 1.76 | 1.51 | 1.40 | 1.32 | 1.34 |
| Wage index | 0.832 | 0.843 | 0.836 | 0.853 | 0.823 | 0.782 | 0.769 |
| Readmissions adjustment | -0.45% | -0.37% | -0.14% | -0.26% | -0.04% | -0.01% | -0.02% |
| Value-based purchasing adjustment | -0.61% | -0.64% | -0.64% | +0.73% | -0.14% | -0.30% | +0.66% |
| Medicare inpatient stays | 877 | 877 | 547 | 597 | 539 | 526 | 478 |
Source: CMS IPPS final rule Impact File (FY 2027).
Organizations Highlands Medical Center reports to Medicare as owners or with operational control. 2 individuals also hold ownership interests; they are not listed here.
The Health Care Authority Of The City Of Huntsville
5% or greater direct ownership interest, since 2021
Sources: CMS Hospital All Owners, CMS Hospital Change of Ownership.
The officers and board members on Highlands Medical Center's Medicare enrollment and on the IRS Form 990 filed under its tax ID.
Source: CMS Hospital All Owners (PECOS), the people the hospital lists on its Medicare enrollment; the first 6 of 11 are shown.
340B drug pricing program
Participating since 2013
340B ID SCH010061-00, registered as a sole community hospital. Authorizing official: Chris Hovanec, Chief Financial Officer, CFO.
Source: HRSA 340B Office of Pharmacy Affairs Information System.
Helipad
Air Evac Base 32
FAA location ID 8AL6, a medical-use heliport 0.1 mi from the hospital.
Source: FAA National Airspace System Resource data, cycle 2026-10-01.
Highlands health & rehab
CCN 015012, certified 1967, Medicare prospective payment
Highlands home health
CCN 017104, certified 1994, Medicare prospective payment
Highlands family medicine llc
CCN 018504, certified 2023, Medicare cost reimbursed
Highlands primary care
CCN 018505, certified 2023, Medicare cost reimbursed
Source: Worksheet S-2 Part I of Highlands Medical Center's latest Medicare cost report (HCRIS).
About Highlands Medical Center's rates and hospital price transparency.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at Highlands Medical Center range from $157 to $580 across 4 insurers. Aetna's rate is $422. The median at nearby comparable hospitals is $623. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Diagnostic colonoscopy (CPT 45378), published negotiated rates at Highlands Medical Center range from $1,122 to $3,902 across 4 insurers. UnitedHealthcare's rate is $1,122. The median at nearby comparable hospitals is $1,611. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Vaginal delivery, hospital stay (MS-DRG 807), published negotiated rates at Highlands Medical Center range from $3,176 to $8,521 across 3 insurers. Blue Cross Blue Shield's rate is $3,176. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at Highlands Medical Center range from $91 to $122 across 3 insurers. UnitedHealthcare's rate is $91. The median at nearby comparable hospitals is $116. 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 Highlands Medical Center range from $5,642 to $23,250 across 3 insurers. Cigna's rate is $22,827. The median at nearby comparable hospitals is $23,752. What a patient pays depends on their plan's deductible, coinsurance and network status.
Highlands Medical Center has a CMS overall hospital star rating of 3 out of 5 on Medicare Care Compare (CMS data released 2026-08-13). That is lower than 42% of US hospitals.
CMS reports no Medicare-funded interns or residents at Highlands Medical Center for fiscal year 2027.
Yes. Under the Hospital Readmissions Reduction Program, Medicare cuts Highlands Medical Center's base inpatient payments by an estimated 0.02% in fiscal year 2027 for more readmissions than expected.
In 2024, the most common were septicemia or severe sepsis without mv >96 hours with mcc (35 discharges), kidney and urinary tract infections without mcc (29 discharges), respiratory infections and inflammations with mcc (22 discharges).
Highlands Medical Center's Medicare case mix index is 1.34 for fiscal year 2027, higher than 13% of hospitals paid under the inpatient prospective payment system.
Highlands Medical Center reported 2,173 inpatient discharges and 7,040 inpatient days from Nov 1, 2024 to Oct 31, 2025.
Highlands Medical Center reported 356 full-time-equivalent employees on payroll from Nov 1, 2024 to Oct 31, 2025.
Highlands Medical Center reported $41M in net patient revenue on $175.6M of gross charges for Nov 1, 2024 to Oct 31, 2025, an operating margin of -62.1%, and net income of -$19.2M.
Highlands Medical Center reported $4.4M of unreimbursed and uncompensated care for Nov 1, 2024 to Oct 31, 2025, including $790,780 of charity care at cost.
Highlands Medical Center's Medicare enrollment lists Jeffrey Howard Samz as CEO since 2021.
Insurers' price transparency files list Highlands Medical Center under employer identification number 63-6004388 ((multi-state) Highlands Medical Center), and 1 other tax ID. 29 health plans and networks list 63-6004388 for it.
Yes. HRSA's 340B database lists Highlands Medical Center (340B ID SCH010061-00) as a participating sole community hospital since 2013.
262 clinicians who bill Medicare list Highlands Medical Center as a hospital affiliation in CMS's Doctors and Clinicians data. The largest groups are diagnostic radiology physician (46), family medicine physician (39), family nurse practitioner (21).
Yes. CMS's Provider of Services file lists ACHC as the accrediting organization for Highlands Medical Center, effective 2003.
In its Medicare enrollment, Highlands Medical Center reports The Health Care Authority Of The City Of Huntsville as 5% or greater direct ownership interest.
CMS lists 27 services at Highlands Medical Center, including Anesthesia, Clinical Laboratory, Coronary Care Unit, CT Scan, Diagnostic Radiology, Dietary Care.
In CMS's 2025 Hospital Service Area file, the most Medicare inpatient stays at Highlands Medical Center came from ZIP codes 35768 (186), 35769 (121), 35744 (47).
Highlands Medical Center has 95 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. 170 are Medicare-certified beds in CMS's Provider of Services file. Facility type: Short Term Acute Care Hospital.
Highlands Medical Center is located at 380 Woods Cove Road, Scottsboro, AL 35768. Its main phone number is (256) 259-4444.
Highlands Medical Center's CMS Certification Number (CCN), also called its Medicare provider number, is 010061.
The National Provider Identifier (NPI) on file for Highlands Medical Center is 1659473916.
Highlands Medical Center lists 21 in-network payers, including Aetna, Ameri Health, Aspirus Health Plan, Banner Health, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
285 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