Price Transparency

CMS Pricing Transparency

In accordance with section 2718(e) of the Public Health Service Act and the regulatory framework under section 2718(b)(3), CMS has established new hospital price transparency mandates. These were detailed in the 2020 Outpatient Prospective Payment System (OPPS) Policy Changes, specifically in the CMS-1717-F2 final rule, published on November 27, 2019, in the Federal Register (84 FR 65524). Seneca Rehabilitation Hospital complies with these federal and state laws by offering all patients complete price transparency and billing information.

Effective January 1, 2024, we’ve updated our standard procedure and charge list. Please note that actual charges may differ according to the medical services required. For specific inquiries or a personalized service quote, contact our Hospital at the provided phone number. Physician fees are separate from our standard charges and billed independently.

Estimate Requests:

Patients can request an estimate of expected charges, which will be provided within 7 business days. These estimates are based on historical averages but can be tailored upon request. We advise patients to consult their health plan for cost-sharing details.

For estimates, contact the hospital’s Controller at the listed phone number.

Key Points to Remember:

• Actual costs may surpass the estimate.
• Physician services, billed separately, might not align with Seneca Rehabilitation Hospital’s insurer network. Contact your healthcare practitioner for network details and a personalized cost estimate..
• Costs might be lower at other facilities or healthcare settings.

Insurance and Payment Details:

Contact your insurance provider for specifics about your coverage, including deductibles and limits. Uninsured patients are encouraged to discuss discount eligibility and payment options with the hospital.

We will bill your insurance first, including Medicare and Medicaid. No interest is charged on post-insurance balances.

Contact the hospital or visit our website for payment plans or financial assistance information.

Legal Background:

Section 2718(e) of the Public Health Service Act mandates U.S. hospitals to publicly disclose standard charges, including diagnosis-related groups (DRGs). Additionally, Section 4421 of the Balanced Budget Act (BBA) of 1997, amended by the BBRA of 1999, authorizes the per-discharge payment system for inpatient rehabilitation hospitals (IRFs) under section 1886(j) of the Social Security Act. This system categorizes patients into case-mix groups (CMGs) for Medicare payment purposes.

Shoppable Services

The Centers for Medicare and Medicaid Services (CMS) categorize “shoppable services” as medical procedures or service packages that patients can schedule in advance. These services are typically non-urgent and allow patients the flexibility to compare prices and schedule appointments at their convenience.

CMS has identified a standard list of 70 Shoppable Services, each with specific billing codes. Hospitals are required to publicly display the negotiated charges for these services based on different managed care plans. In cases where our hospital does not offer a specific service, it will be marked as “NA” in our records. Beyond these 70 services, hospitals are also mandated to disclose prices for an additional 230 services, bringing the total to 300 shoppable services. Our hospital provides a comprehensive list of these services, including the most frequently provided ones, along with their corresponding charges as negotiated with various managed care plans.

For any inquiries or further clarification, please contact us at (304) 398-9800 and request to speak with an admissions representative.

To view our detailed list of Shoppable Services, download the file below

Shoppable Services CSV

Negotiated Charges for Managed Care Plans

Inpatient rehabilitation hospitals, like ours, receive payments from managed care payers or plans based on predefined service categories or programs, also known as “service packages” by CMS. These payments are typically made per day (per diem), per case (per discharge), or on a flat rate basis. Under these payment models, individual procedures and tests are not billed separately; instead, all services are bundled and paid for as a part of the service package. If a managed care plan uses a discount off the total billed charges, the discount is applied across all items on the claim to calculate the hospital’s total payment. The primary billing codes determining payments for these service packages are the Room and Board (R&B) revenue codes, specifically codes 118, 120, 128, 138, 148, and 158. Other revenue codes may appear on the bill but do not affect the payment. For contracts based on a discount off billed charges, individual billing codes for each service listed determine the payment.

The average stay for a patient in an inpatient rehabilitation hospital is about 14 days, but this can vary. Therefore, multiplying the daily rate by 14 provides an estimated total payment if payment is based on a per-day rate. A typical service package in our inpatient rehabilitation hospital includes:

• Room and board services (private or semi-private room)
• All therapy services (physical, occupational, speech, etc.)
• Routine supplies
• Routine medications
• All nursing services

Please note that physician services are billed and paid separately and are not included in this summary.

Occasionally, additional services may be required and billed separately, such as:

• Special equipment
• High-cost pharmacy items
• Dialysis treatments
• High-cost diagnostic services (e.g., CT Scan, MRI)

If “NA” appears under a plan you’re researching, scroll down to find the relevant pricing for that plan. If a plan is not listed, we may not have a contract with that plan. For questions, call us at (304) 398-9800 to speak with an admissions representative for the latest information. Download our detailed list of Payer-Specific Negotiated Charges (CSV format) below:

Payer-Specific Negotiated Charges CSV