Billing, Cedar Falls - Price Transparency
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COVID Testing | Request Price Estimate | Helpful Definitions | Price Disclosure & Lists
COVID-19 Testing
MercyOne Northeast Iowa, a Health Ministry of Trinity Health, presents the following COVID-19 (Corona Virus) test price information for consumers to consider the cost of testing in our facility(ies). Download
Request a Price Estimate
MercyOne supports price transparency and believes it is important for you to know what out-of-pocket costs you will incur for services provided at our Northeast Iowa facilities.
The Centers for Medicare and Medicaid Services have identified 70 shoppable services. If pricing for a shoppable service is not included on the shoppable page, the service is not available from the hospital.
Call or Email for a Price Estimate
By calling 319-272-8000, or complete the price estimate request form, we can give you an estimate of your out-of-pocket costs for a medical service or procedure. We will review the specific service or procedure you will receive and the physician providing the service. We will work with you to review your insurance coverage and provide an average estimate of the charge for the service or procedure.
Use our Searchable Tool for Common Procedures
MercyOne has developed a tool that allows you to search for the costs for some of our most common services and procedures with or without insurance immediately.
Waterloo Search Tool Cedar Falls Search Tool Oelwein Search Tool
Helpful Definitions
Understanding health care terminology around price poses significant challenges for patients. If you ask a group of people to define what "price" is, it is likely you will get a variety of answers. Below are definitions to help frame understanding on this issue:
Charge: The dollar amount assigned to specific medical services before negotiating any discounts from payers. The charge is different from the price. Very few patients pay the charge regardless of their insurance status; and, therefore, this data is not meaningful to people.
Price: The negotiated and contracted amount to be paid to providers by payers (also called the "allowed amount"). A patient's out-of-pocket liability for health care services is based on this allowed amount. Note that the price for a given service varies by insurance plan as these are separately negotiated by plan/employer.
Out-of-Pocket: Portion of the price for medical services and treatment for which the patient is responsible. This includes copayments, coinsurance, and deductibles.
Price Disclosure and Lists
Cost: The definition depends on the cost being referenced: To the provider, cost is the expense incurred to provide health care to patients. To the employer, cost is the expense related to providing health benefits. To the insurance plan, cost is the price paid to the provider. To the patient, cost is the out-of-pocket fees.
The information contained herein is being provided in conjunction with the Centers for Medicare and Medicaid Services (CMS) price transparency requirements necessitating hospitals to provide several different types of charging elements for its standard charges as well as for a list of 300 items and services deemed “shoppable”, i.e., a service that can be scheduled by a healthcare consumer in advance.
By clicking to download this information you agree you have read and understand the following:
- Updates. The information contained in the file(s) is current as of the last upload. This information is subject to periodic changes and the file(s) will be updated as soon as practically possible.
- Charges. It is important to understand the distinction between two different types of charges prevalent in the healthcare industry. The first is “gross charge” that relates to the established prices that are billed to all patients regardless of insurance or health care coverage. The second is “negotiated charge” or prices the insurance companies and payers have agreed to pay for services. A patient with insurance or coverage typically is responsible for a portion of the negotiated charge which will vary based on benefits that are provided by the insurance companies and payers. The portion of the charge that a patient will pay a hospital for services is called the “out-of-pocket” expense.
- File Contents. The file(s) contain the charge amount, charge description, associated accounting/billing code (such as HCPCS, CPT, NDC, DRG, or other payer identifier) of the item or service as reflected in the hospital's charge description master or other internal sources for similar data and or charges from common services packages (collectively referred to as CDM). Additional elements included are five standard charge types – either established and/or allocated – gross charge, discounted cash price, payer-specific negotiated charge, de-identified minimum negotiated charge, de-identified maximum negotiated charge. Further, the payer-specific negotiated charge element is summarized under four de-identified payer bands – Commercial payers (contracted and non-contracted), Managed Medicare payers, Managed Medicaid payers, and Third-Party Liability payers (Workers Comp and Auto).
- Additional Fees. A charge represents the dollar amount assigned to specific medical services before application of any negotiated discounts to third-party payers. The actual hospital charges will vary based on the type of care provided, treatments, individual health conditions and other factors. PLEASE NOTE THESE CHARGES do not include fees from your physician, surgeon, anesthesiologist or other professional services billed by your physician(s) AND OTHER PROFESSIONAL PROVIDERS. Typically, you will be billed separately for these professional services. Most displayed charges herein do include hospital services such as room and bed charges, including operating rooms, recovery rooms and treatment rooms. Other charges such as medication charges, food service charges, anesthesia charges also are typically included with the surgical procedure or MS-DRG charge levels. However, in certain circumstances, they may be displayed separately in charge files or on hospital bills.
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Adjustments. Following the CMS guidelines, the information posted represents the hospital’s current standard charges as reflected in the CDM. However, it is important to understand that the information represented in the CDM is the starting point in many cases and can undergo additional adjustments through the billing process, therefore, please be aware:
- The charge shown is the original charge for the item or service prior to any adjustments that result from applying modifiers in certain situations
- The CDM is used in multiple hospital departments and may have different charges for the same item or service and such instances will repeat in the file. For a single chargemaster item, the charge is consistent; however, there may be slight variation in charges for services with similar descriptions for various reasons
- Charges for certain items or services are based on per unit, such as – including but not limited to – surgeries, anesthesia, and recovery which can be based on the unit of time and complexity; medications, drugs which can be based on weight-based dosage, age or packaging; etc.
- Certain items and or services have a zero-dollar price in the CDM for a variety of reasons – contracted billing services that drop charges externally, no cost supplies, investigational device or medication exemption items in clinical trials and studies, replacement for a recalled or defective device, explode codes and other system limitations. Such items and services will appear with a zero-dollar charge and is not reflective of the actual charge. In addition, items and or services are sometimes assigned a one penny price to reflect, for example, a state provided medication or drug, contrast items, therapy status codes used for CMS reporting, etc. and is not reflective of the actual charge contained outside of the chargemaster
- The file may also contain CDM items for non-charges (such as payments, allowances, transactions, etc.)
- MS-DRG Information. Note on MS-DRG related information: Prior calendar year inpatient discharges are grouped using the current year CMS MS-DRG. The current Medicare year's geographic mean length of stay (LOS) and description is used. The current year is used if the same MS-DRG is present in two Medicare periods. Charges are calculated and displayed by DRG by taking the total charges divided by the total case volume per DRG. Charges are listed for acute inpatients and newborn accounts. The charges to patients with all insurances and payers were included in calculating the charges per DRG. Charges to Rehabilitation and Long-Term Care accounts have been excluded. Also excluded are charges related to error MS-DRGs 0, 998, 999. Individual cases where LOS is greater than the Geographic Mean LOS times 1.5 are excluded. Low volume DRGs where number of cases were < 10 and high dollar outliers are also excluded.
Cautions: The file(s) can be voluminous, and download may take excessive time depending on your internet speed. Please consider the environment before deciding to print. By clicking to download this information you agree you have read and understand the above.
