Mohawk Valley Health System · Utica, NY
201
Beds
6,737
Inpatient discharges a year
$186.1M
Net patient revenue a year
26
In-network payers
St. Elizabeth Medical Center is a 201-bed voluntary non-profit - private hospital in Utica, NY, affiliated with Mohawk Valley Health System. Below you'll find publicly disclosed negotiated rates and facility details, including 26 in-network payers and 105 disclosed rate categories.
The 24 services St. Elizabeth 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.
Medicine & Surgery · Inpatient
MS-DRG 216
$130,727 - $155,936
from 2 insurers · median $143,332
Hospital reports cardiac thoracic surgery services to CMS
Digestive procedures
CPT 45380
$1,696 - $5,436
from 2 insurers · median $3,566
Typical for a hospital with this service line
Digestive procedures
CPT 43239
$5,436
negotiated rate
Typical for a hospital with this service line
Digestive procedures
CPT 45385
$5,436
negotiated rate
Typical for a hospital with this service line
Digestive procedures
CPT 45378
$5,436
negotiated rate
Typical for a hospital with this service line
Medicine & Surgery · Inpatient
MS-DRG 743
$15,593 - $19,270
from 2 insurers · median $17,431
Hospital reports inpatient surgical services to CMS
CT imaging
CPT 74177
$313
negotiated rate
Typical for a hospital with this service line
Medicine & Surgery
CPT 47562
$8,845
negotiated rate
Typical for a hospital with this service line
Medicine & Surgery
CPT 66984
$5,594
negotiated rate
Typical for a hospital with this service line
Medicine & Surgery
CPT 62322 · CPT 62323
$1,796 - $3,825
from 2 insurers · median $2,811
Typical for a hospital with this service line
Gynecology
CPT 58571
$8,845
negotiated rate
Typical for a hospital with this service line
CT imaging
CPT 70450
$72 - $73
from 2 insurers · median $73
Typical for a hospital with this service line
Skin and soft tissue
CPT 10005
$1,796 - $3,825
from 2 insurers · median $2,811
Typical for a hospital with this service line
Ear, nose and throat
CPT 69436
$5,436
negotiated rate
Typical for a hospital with this service line
Mammography
CPT 77067
$124
negotiated rate
Typical for a hospital with this service line
CT imaging
CPT 74176
$111 - $161
from 2 insurers · median $136
Typical for a hospital with this service line
Gynecology
CPT 58661
$8,845
negotiated rate
Typical for a hospital with this service line
Gynecology
CPT 58558
$5,594
negotiated rate
Typical for a hospital with this service line
Orthopedics and pain
CPT 20610
$1,911
negotiated rate
Typical for a hospital with this service line
Orthopedics and pain
CPT 64493
$1,796 - $3,825
from 2 insurers · median $2,811
Typical for a hospital with this service line
CT imaging
CPT 71260
$123 - $162
from 2 insurers · median $142
Typical for a hospital with this service line
Gynecology
CPT 58662
$8,845
negotiated rate
Typical for a hospital with this service line
Nuclear imaging
CPT 78452
$387 - $456
from 2 insurers · median $421
Hospital reports nuclear medicine services to CMS
Ear, nose and throat
CPT 31575
$1,746 - $1,911
from 2 insurers · median $1,829
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* | 18 | 434% | 17 | 1 |
| Insurer B* | 13 | 134% | 5 | 7 |
| Insurer C* | 4 | 57% | 0 | 0 |
How we chose these services: 0 appear in this hospital's own Medicare claims, 0 are common here based on CMS Medicare volume, and 24 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 St. Elizabeth 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
Medicare readmissions penalty (-0.22%)
See quality ratingsDoctors and services
Teaching hospital
Finances
$186.1M net patient revenue
The employer identification numbers (EINs) health plans and networks list for St. Elizabeth 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 |
|---|---|---|
| 15-0532245St Elizabeth Medical Center | 47Aetna, Cigna, United Healthcare (incl Optum, Rocky Mountain, Health Plan of Nevada, Sierra Health), Aspirus Health Plan, Asuris Northwest Health and 42 more | 1821093402 St Elizabeth Medical Center1477641892 St Elizabeth Medical Center1417326661 Syracuse Gastroenterological Associates Pcand 3 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.
2209 Genesee Street, Utica, NY 13501
(315) 798-8100
How Medicare adjusts St. Elizabeth Medical Center's inpatient payments for its readmissions, quality and cost results.
-0.22% on Medicare payments
Readmissions penalty
Hospital Readmissions Reduction Program adjustment for excess readmissions, as estimated in the FY 2026 IPPS final rule.
0.00% on Medicare payments
Value-based purchasing
Hospital Value-Based Purchasing bonus or reduction for quality and cost, as estimated in the FY 2026 IPPS final rule.
Source: CMS IPPS final rule Impact File (FY 2026).
Source: CMS Provider of Services file, as reported by the hospital and state surveyors.
What St. Elizabeth Medical Center reported to Medicare in its latest cost report, covering Jan 1, 2023 to Oct 29, 2023.
6,737
Inpatient discharges
Medicare 29%, Medicaid 3%
37,817
Inpatient days
71% of available bed days used
1,027
Employees (full-time equivalent)
30
Interns and residents (full-time equivalent)
Source: CMS cost report (HCRIS) (report 840769). Figures cover the reporting period, which is not always 12 months, and are self-reported.
Inpatient days and discharges St. Elizabeth Medical Center reported by payer. Medicare and Medicaid include their managed care plans, shown separately below.
| Medicare | Medicaid | Other | Total | |
|---|---|---|---|---|
| Inpatient days | 11,720 | 983 | 25,114 | 37,817 |
| Discharges | 1,981 | 188 | 4,568 | 6,737 |
| Average length of stay | 5.9 days | 5.2 days | 5.5 days | 5.6 days |
| Average daily census | 38.8 | 3.3 | 83.2 | 125.2 |
14,560
Medicare Advantage days
2,524 discharges
5,383
Medicaid managed care days
768
Observation bed days
| Unit | Beds | Inpatient days | Medicare days | Occupancy |
|---|---|---|---|---|
| Adults & pediatrics | 119 | 23,365 | 7,132 | 65% |
| Intensive care unit | 16 | 4,035 | 1,659 | 84% |
| Coronary care unit | 9 | 2,174 | 80% | |
| Subprovider - ipf | 24 | 3,919 | 442 | 54% |
Source: CMS cost report (HCRIS, Form 2552-10), report 840769, amended. Hospitals report these figures themselves; they are not audited financial statements. Worksheet S-3 Part I.
Revenue, expenses and income St. Elizabeth Medical Center reported to Medicare for Jan 1, 2023 to Oct 29, 2023. Percentages are of net patient revenue.
| Line | Amount | Share |
|---|---|---|
| Gross patient revenue (charges) | $820.5M | 440.9% |
| Inpatient | $456.9M | 245.5% |
| Outpatient | $363.6M | 195.3% |
| Contractual allowances and discounts | -$634.4M | -340.9% |
| Net patient revenue | $186.1M | 100.0% |
| Operating expenses | -$213.3M | -114.6% |
| Operating income from patient care | -$27.2M | -14.6% |
| Other income | -$10.5M | -5.6% |
| Contributions and donations | $6.1M | 3.3% |
| Investment income | $689,613 | 0.4% |
| Government appropriations | $289,211 | 0.2% |
| Other | -$17.6M | -9.4% |
| Other expenses | $2.1M | 1.1% |
| Net income | -$35.5M | -19.1% |
| Line | Amount | Share |
|---|---|---|
| Traditional Medicare | $153.5M | 19.4% |
| Medicaid (including managed care) | $164.2M | 20.7% |
| Other payers and self-pay | $475.4M | 59.9% |
| Total charges | $793.1M | 100.0% |
Source: CMS cost report (HCRIS, Form 2552-10), report 840769, amended. 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 St. Elizabeth Medical Center's latest cost report, which covers 302 days; income and expense figures are scaled to a year.
-14.6%
Operating margin
Operating income from patient care / net patient revenue
-20.2%
Total margin
Net income / net patient revenue plus other income
-17.8%
EBITDAR margin
Net income before interest, depreciation and leases (Worksheet A-7), / total revenue
62% of expenses
Personnel costs
Salaries, direct-care contract labor and core wage-related costs / operating expenses
$36.13
Average hourly wage
Adjusted salaries / paid hours (Worksheet S-3 Part II)
-111.4%
Return on assets
Net income for a year / total assets
1.75
Current ratio
Current assets / current liabilities
1.38
Quick ratio
Cash, temporary investments and net receivables / current liabilities
28 days
Days cash on hand
Cash and temporary investments / daily operating expenses excluding depreciation
9 days
Days in patient receivables
Net patient receivables / daily net patient revenue
26 days
Average payment period
Current liabilities / daily operating expenses excluding depreciation
5.51
Asset turnover
Total revenue for a year / total assets
1.4 years
Average age of plant
Accumulated depreciation / depreciation for a year
Source: CMS cost report (HCRIS, Form 2552-10), report 840769, amended. Hospitals report these figures themselves; they are not audited financial statements.
What St. Elizabeth Medical Center owned and owed at the end of its reporting period (Oct 2023), across all fund types: $38.6M in total assets and a -$2.8M fund balance.
| Line | Amount | Of total assets |
|---|---|---|
| Cash and temporary investments | $19.4M | 50.2% |
| Patient receivables, net | $5.5M | 14.4% |
| Total current assets | $31.7M | 82.2% |
| Property and equipment, net of depreciation | $5.7M | 14.8% |
| Investments and other assets | $1.1M | 3.0% |
| Total assets | $38.6M | 100.0% |
| Current liabilities | $18.1M | 46.9% |
| Long-term debt | $7.4M | 19.1% |
| Total liabilities | $41.3M | 107.2% |
| Fund balance (net assets) | -$2.8M | -7.2% |
Source: CMS cost report (HCRIS, Form 2552-10), report 840769, amended. Hospitals report these figures themselves; they are not audited financial statements.
Care St. Elizabeth Medical Center provided without full payment, as reported on Worksheet S-10 of its cost report.
$587,784
Cost of charity care
Care for patients approved for charity care and uninsured discounts, at cost
$9.2M
Bad debt
Patient bills written off as uncollectible, at charges
$7.9M
Medicaid shortfall
Cost of Medicaid patients (charges times the cost-to-charge ratio) minus Medicaid payments; negative means a surplus
$10M
Total unreimbursed and uncompensated care
4.7% 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 840769, amended. Hospitals report these figures themselves; they are not audited financial statements.
St. Elizabeth Medical Center'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 | Oct 2023 |
|---|---|---|---|---|---|
| Net patient revenue | $201M | $185.1M | $203.4M | $219.4M | $186.1M |
| Operating expenses | $216.7M | $209.1M | $211.8M | $237.9M | $213.3M |
| Operating margin | -7.8% | -13.0% | -4.1% | -8.5% | -14.6% |
| Net income | -$3.8M | -$8.8M | -$1.7M | -$8.6M | -$35.5M |
| Total assets | $117.2M | $139M | $133.2M | $129M | $38.6M |
| Discharges | 9,261 | 7,870 | 7,844 | 7,623 | 6,737 |
| Inpatient days | 45,836 | 44,211 | 46,586 | 44,402 | 37,817 |
| Medicare Advantage days | 14,965 | 14,388 | 16,932 | 16,098 | 14,560 |
| Beds | 201 | 201 | 201 | 201 | 201 |
| Employees (FTE) | 1,555 | 1,500 | 1,109 | 1,160 | 1,027 |
Source: CMS cost report (HCRIS, Form 2552-10), report 840769, amended. Hospitals report these figures themselves; they are not audited financial statements.
Each cost center St. Elizabeth 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 |
|---|---|---|---|---|---|
| Impl. dev. charged to patients | $19.8M | $103.8M | 0.19 | ||
| Laboratory | $5M | $14.9M | $96.2M | 0.15 | 12,360 |
| Medical supplies charged to patient | $13.5M | $31.1M | 0.43 | ||
| Clinic | $7.5M | $13M | $6.1M | 2.13 | 1,910 |
| Operating room | $3.7M | $11.6M | $46M | 0.25 | 22,757 |
| Emergency | $2.8M | $11.4M | $90M | 0.13 | 17,169 |
| Drugs charged to patients | $9.4M | $21.2M | 0.44 | ||
| Cardiac catheterization | $3.9M | $8.6M | $73.3M | 0.12 | 21,313 |
| Radiology-diagnostic | $2.8M | $5.6M | $41M | 0.14 | 16,447 |
| Cardiac surgery | $1.8M | $4M | $10.1M | 0.39 | 9,028 |
| Respiratory therapy | $2.4M | $3.9M | $14.9M | 0.26 | 2,763 |
| Asc (non-distinct part) | $1M | $1.9M | $6.7M | 0.29 | 14,401 |
| Blood storing processing & trans. | $178,660 | $1.8M | $2.1M | 0.87 | 644 |
| Ct scan | $780,040 | $1.7M | $67.5M | 0.03 | 2,623 |
| Recovery room | $880,077 | $1.4M | $3.8M | 0.38 | 4,351 |
| Physical therapy | $724,777 | $1.3M | $2.7M | 0.48 | 4,286 |
| Wound care | $670,882 | $1.1M | $5.7M | 0.20 | |
| Occupational therapy | $651,121 | $1M | $3.7M | 0.28 | 2,149 |
| Sleep lab | $730,541 | $988,484 | $4.1M | 0.24 | |
| Observation beds (non-distinct part | $863,148 | $7.8M | 0.11 | ||
| Electroencephalography | $184,987 | $3.6M | 0.05 | 852 |
| Department | Salaries | Total cost | Charges | Cost-to-charge | Square feet |
|---|---|---|---|---|---|
| Adults & pediatrics | $7.7M | $27.1M | $56.8M | 0.48 | 46,278 |
| Special care unit | $4.1M | $9.3M | $40.2M | 0.23 | 11,178 |
| Intensive care unit | $3.2M | $8.5M | $29M | 0.29 | 16,084 |
| Coronary care unit | $1.6M | $5.9M | $15.8M | 0.37 | 7,327 |
| Subprovider - ipf | $1.6M | $3.8M | $9.8M | 0.39 | 10,684 |
| Department | Salaries | Direct cost | Paid hours | Average hourly wage | Square feet |
|---|---|---|---|---|---|
| Employee benefits department | $45,309 | $18.2M | 1,720 | $26.34 | |
| Administrative & general | $7.7M | $16.4M | 272,363 | $26.74 | 31,463 |
| Operation of plant | $1.3M | $4.8M | 45,178 | $28.71 | 58,218 |
| Cap rel costs-mvble equip | $3.9M | ||||
| Dietary - other | $1.3M | $3.7M | 27,034 | ||
| Pharmacy | $2.7M | $3.1M | 6,816 | ||
| Housekeeping | $1.6M | $2.5M | 80,221 | $21.04 | 3,365 |
| Supervising physicians - teaching | $14.5M | $2M | |||
| I&r services-salary & fringes apprv | $1.6M | $2M | 1,112 | ||
| Medical records & library | $929,886 | $1.2M | 36,291 | $25.62 | 6,973 |
| Nursing administration | $1.8M | $1.1M | 5,631 | ||
| Nursing program | $2.1M | $1M | |||
| Central service & supply | $512,134 | $837,955 | 9,400 | ||
| Laundry & linen service | $134,630 | $730,958 | 7,363 | $18.28 | 3,051 |
| Cap rel costs-bldg & fixt | $585,584 | 383,064 | |||
| Social service | $455,182 | 13,955 | $32.56 | ||
| Cafeteria | -$677,259 |
Source: CMS cost report (HCRIS, Form 2552-10), report 840769, amended. 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 St. Elizabeth Medical Center for an inpatient stay.
1.90
Case mix index
Higher than 71% 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
0.13 residents per bed
Medicare-funded interns and residents per bed (FY 2026).
23.7%
Low-income patient share
Disproportionate share percentage: Medicaid and SSI patient days CMS uses for safety-net payments (FY 2026).
195
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).
| IPPS fiscal year | FY 2021 | FY 2022 | FY 2023 | FY 2024 | FY 2025 | FY 2026 |
|---|---|---|---|---|---|---|
| Case mix index | 1.75 | 1.75 | 1.94 | 1.99 | 1.94 | 1.90 |
| Wage index | 0.940 | 0.967 | 0.946 | 1.218 | 1.306 | 1.370 |
| Readmissions adjustment | -0.76% | -0.48% | -0.50% | -0.78% | -0.22% | -0.22% |
| Value-based purchasing adjustment | -0.83% | -1.07% | -1.07% | -0.60% | -1.18% | 0.00% |
| Medicare inpatient stays | 3,252 | 3,252 | 2,461 | 2,402 | 2,401 | 195 |
Source: CMS IPPS final rule Impact File (FY 2026).
The officers and board members on St. Elizabeth Medical Center's Medicare enrollment and on the IRS Form 990 filed under its tax ID.
St Elizabeth Community Health Support files the Form 990 for the tax ID insurers list for St. Elizabeth Medical Center, so these people may lead the wider organization rather than St. Elizabeth Medical Center alone.
| Name | Title |
|---|---|
| Darlene Stromstad | President/ceo |
| Robert Scholefield | Senior Vp/coo, Former |
| Louis Aiello | Senior Vp/cfo |
| Jerome Dayao Dnpmsrnnea-Bcccrn-K | Senior Vp/cno, Former |
| William Lecates MD | Senior Vp/coo |
| Gary D Zimmer MD | Senior Vp/cmo |
| Richard Zweifel | Chairman |
| Karen Leach | Vice Chairman |
| Domenic P Aiello MD | Secretary |
| John Brumstead MD | Treasurer |
| Richard Tantillo | Philanthropy Chair |
Board members: Sushma Kaul MD, Joan Compson, Norman Siegel, Gregory Evans, Catherine Brownell PhD, Catherine Cominsky, Andrew Kowalczyk III, Michael Kelberman MD, Robert Dicks, Rob Myers.
Source: IRS Form 990 Part VII filed by St Elizabeth Community Health Support (EIN 15-0532245), via the IRS e-file data. A health system's return can cover several hospitals.
St. elizabeth psych unit
CCN 33S245, certified 1986, Medicare prospective payment
St. elizabeth med ctr swing beds
CCN 33U245, certified 2020, Medicare prospective payment
Source: Worksheet S-2 Part I of St. Elizabeth Medical Center's latest Medicare cost report (HCRIS).
About St. Elizabeth Medical Center's rates and hospital price transparency.
For CT abdomen and pelvis with contrast (CPT 74177), published negotiated rates at St. Elizabeth Medical Center range from $313 to $313 across 1 insurers. Aetna's rate is $313. The median at nearby comparable hospitals is $439. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Colonoscopy with biopsy (CPT 45380), published negotiated rates at St. Elizabeth Medical Center range from $1,696 to $5,436 across 2 insurers. UnitedHealthcare's rate is $5,436. The median at nearby comparable hospitals is $1,926. What a patient pays depends on their plan's deductible, coinsurance and network status.
For Screening mammography, bilateral (CPT 77067), published negotiated rates at St. Elizabeth Medical Center range from $124 to $124 across 1 insurers. Aetna's rate is $124. The median at nearby comparable hospitals is $146. What a patient pays depends on their plan's deductible, coinsurance and network status.
Yes. CMS counts 0.13 Medicare-funded residents per bed at St. Elizabeth Medical Center for fiscal year 2026, so it is a teaching hospital.
Yes. Under the Hospital Readmissions Reduction Program, Medicare cuts St. Elizabeth Medical Center's base inpatient payments by an estimated 0.22% in fiscal year 2026 for more readmissions than expected.
St. Elizabeth Medical Center's Medicare case mix index is 1.90 for fiscal year 2026, higher than 71% of hospitals paid under the inpatient prospective payment system.
St. Elizabeth Medical Center reported 6,737 inpatient discharges and 37,817 inpatient days from Jan 1, 2023 to Oct 29, 2023.
St. Elizabeth Medical Center reported 1,027 full-time-equivalent employees on payroll from Jan 1, 2023 to Oct 29, 2023.
St. Elizabeth Medical Center reported $186.1M in net patient revenue on $820.5M of gross charges for Jan 1, 2023 to Oct 29, 2023, an operating margin of -14.6%, and net income of -$35.5M.
St. Elizabeth Medical Center reported $10M of unreimbursed and uncompensated care for Jan 1, 2023 to Oct 29, 2023, including $587,784 of charity care at cost.
Insurers' price transparency files list St. Elizabeth Medical Center under employer identification number 15-0532245 (St Elizabeth Medical Center). 47 health plans and networks list 15-0532245 for it.
CMS lists 30 services at St. Elizabeth Medical Center, including Adult Inpatient Psychiatric Care, Anesthesia, Cardiac Catheterization Lab, Cardiac Thoracic Surgery, CARF Inpatient Rehabilitation (Commission On Accreditation Of Rehabilitation Facilities Inpatient Rehabilitation), Chemotherapy.
St. Elizabeth Medical Center has 201 beds, including its psychiatric, rehabilitation and other subprovider units, in its latest Medicare cost report. Facility type: Short Term Acute Care Hospital.
St. Elizabeth Medical Center is located at 2209 Genesee Street, Utica, NY 13501. Its main phone number is (315) 798-8100.
St. Elizabeth Medical Center's CMS Certification Number (CCN), also called its Medicare provider number, is 330245.
The National Provider Identifier (NPI) on file for St. Elizabeth Medical Center is 1821093402.
St. Elizabeth Medical Center is affiliated with Mohawk Valley Health System.
St. Elizabeth Medical Center lists 26 in-network payers, including Aetna, Ameri Health, Avera Health Plans, BCBS, and is Medicare-certified. Insurance acceptance may vary by plan, so confirm coverage with your insurer or the hospital's billing department.
105 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