List of Charges
Glossary of Terms

 

Price Transparency - Glossary of TermsHere are definitions to some common terms you may see while reviewing our list of charges.

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C

Charge

The dollar amount a provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid.

Cost

The definition of cost varies by the party incurring the expense:

  • To the patient, cost is the amount payable out of pocket for health care services.
  • To the provider, cost is the expense (direct and indirect) incurred to deliver health care services to patients.
  • To the insurer, cost is the amount payable to the provider (or reimbursable to the patient) for services rendered.
  • To the employer, cost is the expense related to providing health benefits (premiums or claims paid).

CPT Code

CPT code is a five digit numeric code which represents procedures and services provided to a patient. These CPT codes are used in the outpatient hospital billing process when submitting claims to the insurance company.

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D

DRG

A diagnosis-related group (DRG) is a patient classification system that standardizes prospective payment to hospitals and encourages cost containment initiatives. In general, a DRG payment covers all charges associated with an inpatient stay from the time of admission to discharge.

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M

MS-DRG

This is a classification system (referred to as DRGs) for inpatient discharges and adjust payments under the Inpatient Prospective Payment System (IPPS) based on appropriate weighting factors assigned to each DRG. Under the IPPS, we pay for inpatient hospital services on a rate per discharge basis that varies according to the DRG to which a beneficiary's stay is assigned. The formula used to calculate payment for a specific case multiplies an individual hospital's payment rate per case by the weight of the DRG to which the case is assigned.  Each DRG weight represents the average resources required to care for cases in that particular DRG, relative to the average resources used to treat cases in all DRGs

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O

Out-of-Pocket Payment

The portion of total payment for medical services and treatment for which the patient is responsible, including copayments, coinsurance and deductibles.

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P

Price

The total amount a provider expects to be paid by payers and patients for health care services.

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