The charts available below provide average charges for Regional One Health. These tables are updated annually and are based on the patient charges actually incurred for these services during the previous twelve months of our fiscal year. They may be used by patients to estimate the charge they may incur for services.
Please note that these are only charge estimates and are subject to change without notice. Drugs, implants, and supply charges are based on acquisition costs so the charge could be different each time we purchase new items. Also, the charge for your services may be higher or lower based on factors specific to your case.
It is also important to understand that the charge is very different from the actual payment a hospital expects to receive for services. Medicare and Medicaid set the rates they will pay for services related to care of their patients. Commercial and TennCare payers negotiate discounted rates with hospitals and physicians.
These estimates reflect hospital charges only. They do not include physician or other provider fees that are not billed by Regional One Health. You may receive bills from multiple physicians for their services, including but not limited to your anesthesiologist, hospitalist, pathologist, radiologist, cardiologist, emergency room physician, and other specialists who participate in your care. If you have questions regarding the bill for their services, please contact the individual provider.
All of Regional One Health’s hospital-based specialties– anesthesiologists, pathologists, radiologists, and emergency room physicians– participate in all of the same insurance plans as Regional One Health, meaning there will not be a time when you are receive in-network rates for Regional One Health services and out-of-network rates for physician services for one of these specialties.
If you have questions regarding an estimated charge, please contact our Revenue Integrity staff at 901-545-7745.
Glossary of Terms
Inpatient Hospital Care in which the patients remain under constant care
Payment category used to classify patients for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual cost incurred. The primary APC represents the highest weighted (most complex) procedure performed. The charges listed include all services (surgical procedures, supplies, drug costs, etc.) performed on the date of service.
The average charge amount is calculated by adding the total hospital charges for all patients in the last 12 months who obtained a specific outpatient test or procedure. This total number is then divided by the number of patients in that same category.
The average charge per day amount is calculated by adding all of the hospital charges for all patients in the last 12 months who obtained a service. This total number is then dived by the length of stay for the patients in the same category.
The average charge amount is calculated by adding the total hospital charges for all patients in the last 12 months who obtained a specific outpatient test or procedure. This total number is then divided by the number of units in that same category.
CPT® is a registered trademark of the American Medical Association (“AMA”). Current Procedural Terminology (CPT) codes are numbers assigned to services and procedures performed for patients by medical practitioners. The codes are part of a uniform system maintained by the American Medical Association (AMA) and used by medical providers, facilities and insurers. Each code number is unique and refers to a written description of a specific medical service or procedure. CPT codes are often used on medical bills to identify the charge for each service and procedure billed by a provider to you and/or your insurer. Most CPT codes are very specific in nature. For example, the CPT code for a fifteen-minute office visit is different from the CPT code for a thirty-minute office visit.
Services provided by the hospital or hospital-based department
Inpatient Procedure require that the patient by admitted into the hospital for at least one overnight stay.
Care Provided in an inpatient setting for patients that need additional help to recover from an injury
Specilaty care for patients with serious medical problems that require intense, special treatment for an extended period of time- usually 20 to 30 days
Major Diagnostic Categories (MDC) are formed by dividing all possible principal diagnosis into exclusive areas. The diagnoses in each MDC correspond to a single organ system or etiology, and in general are associated with a particular specialty. MDC 0 (Pre) can be reached from a number of different diagnosis or procedures- usually related to transplants or ventilators.
The maximum charge per case is the highest charge per case in the last 12 months for patients that received services grouped by either MS-DRG (inpatient) or primary APC (outpatient).
The Median Charge Per Case represents the middle charge her case in the last 12 months who obtained services grouped to an MS-DRG (inpatient) or Primary APC (outpatient). The probability of falling above this charge or below it is equal.
Lists the Hospital Outpatient Prospecitve Payment System (OPPS) classifications and rates by CPT. This system is used by Medicare, Medicaid, VA, Tricare, and other payors to determine how hospital outpatient services will be paid. Services that are not billed with a CPT are not separately payable under OPPS.
The Status Indicator listed in Addendum B explains the payment methodology used by OPSS for each CPT.
The minimum charge per case is the lowest charge per case in the last 12 months for patients that received services grouped by either MS-DRG (inpatient) or Primary APC (outpatient).
Payment category used to classify patients and for the purpose of reimbursing hospitals for each case in a given category with a fixed fee regardless of the actual costs incurred and that are based especially on the principal diagnosis, surgical procedure used, age of patient, and expected length of stay in the hospital
Services that are provided by the physician or medical group. These services are billed in addition to the facility services.
An outpatient procedure is one that is performed in the hospital or hospital-based deparment and does not require an overnight stay
A Per Diem is a per day rate that is multiplied by the patients length of stay to determine reimbursement.
Anesthesiologist help ensure safety and comfort for patients undergoing surgery by administering general anesthesia (putting the patient to sleep), sedation (IV medications that make patients calm and/or unaware), or regional anesthesia (injections of anesthesia near nerves to numb the part of the body being operated on. The professional part of these services is separately billed by the Anesthesiologist’s office
High level of medical care for patients that are no longer in need of acute services, but require additional medicare care from trained individuals (nurses) before they go home.
List of MS-DRGs that is updated annually by CMS which includes the DRG weights and arithmetic mean length of stay, as well as the geometric length of stay.