||Charge Master- Last Updated 12.31.2021
is updated annually with new charges and rates as applicable.
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
|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 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
|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.
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.
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.
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
|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
|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.
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.
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
payors may also provide additional reimbursement to base rates after documentation of meeting certain quality metrics or other
factors specific to the provider.
questions, please contact Misty Avilez at 979-232-7009