Due to the Center for Medicare and Medicaid Services’ (CMS) recently finalized new regulations regarding Price Transparency, hospitals must:
- Publish a comprehensive machine readable file with pricing for all items and services, and
- Display pricing for shoppable services in a consumer friendly format
We are dedicated to providing price and cost information to our patients, as well as providing all of the required detailed information under the CMS rule. That includes publishing on our website a machine-readable file that complies with the CMS requirements but is not necessarily intended for direct patient interpretation. Machine-readable means the data can be imported or read into a computer system for further processing.
What Do These Charges Mean?
Medicare has defined several different types of standard charges that should be available for patients to see. They are:
- Gross charges
- Discounted cash price
- Payer-specific negotiated charge
- De-identified minimum negotiated charge
- De-identified maximum negotiated charge
The gross charge is the full list price from the hospital chargemaster or CDM (charge description master). Each hospital sets a gross charge for every individual service rendered to patients within their chargemaster. These gross charges do not include any discounts that may be offered, and they serve as the starting point from which payment is negotiated with individual insurance payers for specific insurance plans. As a patient receives services throughout the hospital visit, a charge for each service provided is generated on the patient’s account resulting in a claim that is submitted to the patient’s insurer.
Patients will almost never pay the listed gross charge for healthcare services. However, under federal law, all insurers, including Medicare and Medicaid, must be billed the amount listed on the chargemaster for those services.
Gross charges can vary, sometimes greatly, from hospital to hospital for the same procedure or service based on how each hospital manages its charges and costs. Charges can vary based on geography, physician supply and medication preferences, the kinds of services the facility typically provides, and the expertise required to deliver these services. Depending on which (if any) group purchasing organization the hospital is a part of, drug and supply costs can also vary greatly.
Discounted Cash Price
The discounted cash price is the price offered to patients willing to pay in cash at the time of service without involving insurers. This is often referred to as the self-pay price.
Payer-Specific Negotiated Charge
The payer-specific negotiated charge is the charge that a hospital has negotiated with a third-party payer for an item or service. This negotiated charge amount will likely vary from payer to payer and even between insurance plans for the same insurance payer.
De-identified Minimum Negotiated Charge
The de-identified minimum negotiated charge is the lowest charge that a hospital has negotiated across all insurers for an item or service.
De-identified Maximum Negotiated Charge
The de-identified maximum negotiated charge is the highest charge that a hospital has negotiated with all insurers for an item or service.
Understanding the Price Transparency Machine-Readable File
When you access the machine-readable file, you will find three tabs of information. Below is an explanation of what each of these items mean.
This is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital – each test, exam, surgical procedure, room charge, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.
The chargemaster amounts are billed to an insurance company, Medicare, or Medicaid, and those insurers then apply their contracted or fee schedule rates to the services that are billed.
All Service Items
The All Service Items price list is based on information we have gathered from our claims and insurance payment files. This is machine-readable information containing required data elements under the CMS rule and is not necessarily intended for direct patient consumption. This is not a guarantee of what you will be charged. Your actual charges may differ from the estimated charges for many reasons including the seriousness of your medical condition, the actual time the procedure takes, and the services and supplies that you receive. If you have insurance, your benefits will ultimately determine the amount you owe (including deductibles, co-pay, co-insurance, and out-of-pocket maximums).
The high degree of variation in charging practices and differences in reimbursement methodologies between insurance payers make it difficult for patients to get the intended full-benefit of “pricing transparency.” Medicare wanted to give patients another way to compare prices, so the requirement asked hospitals to make prices available for shoppable services or items in a patient-friendly format.
Medicare defines "shoppable services" as services that typically can be scheduled by a patient in advance on a non-urgent basis. Medicare has identified 70 shoppable services that all hospitals should include and has asked hospitals to choose at least 230 additional shoppable services that they perform most frequently.
Shoppable services are available in our self-service cost estimation tool.
Accessing Our Pricing Data
The following links will take you to the "All Service Items" and "Chargemaster" information for each hospital required under the CMS Price Transparency Rule as a machine-readable file.
- Froedtert Hospital Pricing Data
- Froedtert Menomonee Falls Hospital Pricing Data
- Froedtert West Bend Hospital Pricing Data
- Froedtert Holy Family Memorial Hospital Pricing Data
- Froedtert Community Hospital Pricing Data (Froedtert Community Hospital — Mequon, Froedtert Community Hospital — New Berlin, Froedtert Community Hospital — Pewaukee and Froedtert Community Hospital — Oak Creek)
Notes about viewing and searching for information when accessing the links above:
- The "All Service Items" page will contain the following information as a string of text and numbers: Description; Associated Codes (e.g. CPT/HCPCS, DRG); Average Gross Charge; Cash Discount; Payer-Specific Negotiated Charge; Deidentified Minimum Charge; Deidentified Maximum Charge. The presentation of this data is specifically for machine readability and is not meant for patient use.
- To see all data, please type ** into the search box and hit enter on your keyboard, and you will be presented with all services.
Other Pricing Resources
Wisconsin Act 146 (2009) tells health care providers in our state how to give you price and quality information. The PricePoint links below give information about what we charge for the care given most often in Wisconsin. The data are averages and do not represent the actual charges you may be billed or your out-of-pocket costs.
- PricePoint information for Froedtert Hospital
- PricePoint information for Froedtert Menomonee Falls Hospital
- PricePoint information for Froedtert West Bend Hospital
- Froedtert Holy Family Memorial
- Froedtert Community Hospital – Mequon
- Froedtert Community Hospital - New Berlin
- Froedtert Community Hospital - Oak Creek
- Froedtert Community Hospital – Pewaukee
Note: The data may not include all the charges you need. For example, this information does not include fees for physician services or anesthesia administration. Those charges are billed separately by the physician.