Rice Medical Center
  Charge Master- Last Updated 12.31.2021
DISCLOSURES
Data Updates Data is updated annually with new charges and rates as applicable.
Data Limitations Please note, this readable file includes all of the active contracts on file for this hospital.  If for any reason, you do not find your applicable insurance company or product, please notify us immediately and we will assist you in identifying your insurance network, product or payor.  Given your payor is not included in the file, this may be because the hospital does not have a contract with that payor or there has been no utilization.  If it is determined that the hospital does have a contract with the payor,  the file will be updated as soon reasonable possible to include all required information.   
Data is limited to information provided by facility and insurance companies at the time of development of this tool.
Insurance companies may apply different methodologies such as bundling codes, reducing reimbursement on multiple procedures as well as deny some cpt codes as non-reimbursed, thus reducing the reimbursement noted in the tool. 
Discounted Rates The discounted cash price is applied when patients have no insurance in which to file claims and pay for services.  Certain conditions such as prompt payment at time of service  may be a condition of receiving this discounted price.
Those with financial needs that meet certain charity  or indigent  care guidelines may be eligible for further discounts on the prices noted in the data. This is subject to review through a formal application process. 
Critical Access Hospital  Rice Medical Center  is a Critical Access Hospital and is paid by Medicare the following:  $3,865 per day for inpatient acute care and $2,952 per day for inpatient skilled care).  The hospital is paid 67% of billed charges for outpatient services).  All Medicare Advantage plans reimburse the same way.
 As a Critical Access Hospital, Rice Medical Center  was paid  39% of billed charges overall by Texas Medicaid in the last year.  This reimbursement may vary depending on Medicaid cost settlements and supplemental payment programs.

 
Medicare deductibles may vary by Medicare Advantage Plan.  Please check your benefit design to determine your out of pocket responsibility.
As a Critical Access Hospital, Rice Medical Center  is paid based on cost to charge ratios for worker compensation claims in the Texas jurisdiction.  Some contracts may provide a further discount from this rate and is denoted on the readable files.  
Rural Health Clinic Rice Medical Center offers Medicare patients clinic services through a designated Rural Health Clinic (RHC).  They offer 2 RHC's.  East Bernard is paid $199.39 and Eagle Lake is paid $227.61.      This is an all inclusive rate for all services provided with a few exception in which vaccines, chronic care and ancillary services may be paid separately based on the Medicare fee schedule at the time of services.   
Rice Medical Center offers Medicaid patients clinic services through a designated Rural Health Clinic (RHC).  They offer 2 RHC's.  East Bernard is paid $64.72, Eagle Lake is paid $64.72.    This is an all inclusive rate for all services provided with a few exception in which vaccines, chronic care and ancillary services may be paid separately based on the Medicare fee schedule at the time of services.   
Professional Fees Please note, the charge master includes other hospital and clinic charges.  For simplification, they are broken out into two separate tools for review.   
Rice Medical Center employs or is contracted with the following specialties and may bill for their services in addition to the facility fee.  Examples are included in the packaged services included with this tool. Specialties include:  anesthesiology, emergency, fast track and wound care.
Depending on how the professional fees are billed and which payor contract they are tied to, reimbursements may vary.  For purposes of this tool, professional fees are showing paid as per the hospital contracted rates on the hospital charge master and shoppables.  Rates shown on the clinic charge master are shown as paid under a medical group agreement. 
Reimbursement may vary depending on the location in which it is provided.   Physicians/provider services performed in a clinic setting will be paid at a global rate which includes both the facility (technical component) and the professional (physician/provider fee).  The same Physician/provider services performed in a hospital setting, the physician/provider will be paid just the professional fee.   For purposes of this tool, global rates are being used for evaluation and management services.  
Community Health Care System does not bill for the professional component on radiology or pathology and therefore, additional charges will be billed by an outside party when these services are provided. 
In regard to anesthesiology fees, although they are a separate bill type from the facility bill type, the payment rate for this tool is applying the hospital rates as contracted with the payors.  The actual payment may vary, given the payor applies a physician contract to pay rates.  
Some payors may reimburse mid-level providers less than physicians for the same services.  On average, payors may reimburse 80-85% of the physician fee schedules noted in the tool.
Packaged Services Charges for packaged services denoted on the shoppables are based on a typical claim and charges may vary based on the clinical needs of the patients both before and during the procedure.  Charges that may vary for the following reasons include but are not limited to patient clinical conditions and co-morbidities, anesthesia time, operating room time, supplies, complications during the procedure.  
Out of Pocket Variances Insurance company policies and benefit design, including what services are considered allowed and payable may differ  for each beneficiary and  can impact the estimate noted in this data. Those utilizing the data to determine their out of pocket responsibility are strongly encouraged to contact their insurance agent and confirm their specific benefit design and out of pocket estimates as it applies to the services being considered. 
Reimbursement related to quality and other factors Some payors may also provide additional reimbursement to base rates  after documentation of  meeting certain quality metrics or other factors specific to the provider. 
Contact Information For further questions, please contact Misty Avilez at 979-232-7009