Price Transparency

INTRODUCTION

At Caribbean Medical Center, we continually strive to provide superior healthcare and transparency for the members of our community. The details of healthcare billing and insurance can be difficult to understand due to issues like confusing terminology and complex insurance information. In compliance with the Centers for Medicare and Medicaid Services (CMS), Caribbean Medical Center is expanding transparency by providing the public with a directory of our standard charges, known as a “Charge Master” (or “CDM”) and a “Shoppable Services” directory.

The Charge Master and Shoppable Services files are directories of healthcare services provided by the hospital, including the standard charge for each service. Before searching through the Charge Master or Shoppable Services files, it is important to note that the hospital’s standard charge is NOT the same as what you or your insurance company typically pays for a service. The standard charge is a combination of the full operating expenses involved in providing healthcare, both direct expenses (direct nursing care, meals, supplies, etc). and indirect expenses (i.e. a fraction of total operating costs like new equipment, non-clinical staff, building & utility expenses, etc It is used for self pay patients. Standard charges are also simply a tool that hospitals or health providers use to negotiate discounts in contracts with insurance companies and to evaluate the financial impact of those discounts on the financial health of their institution. Standard charges are the same for all patients, but a patient’s financial portion of a hospital bill will primarily depend on the financial payment negotiated by insurance companies with the hospital.

In addition, for uninsured patients our hospital does not have a discount policy in place. Please contact the Caribbean Medical Center at 787-801-0081 for any related question, Billing department.

CHARGE MASTER(CDM) STANDARD CHARGES FILE:

The Charge Master is a machine-readable file listing all Caribbean Medical Center’ services. CMS developed a list of elements it requires hospitals to list in a publicly available file identifying the hospital’s standard charges and other transparency information on their website. The Charge Master file contains a specific healthcare industry code, service description, and standard billed charge for each service the hospital or clinic renders. Added to the usual Charge Master items listed above, the Charge Master file includes the minimum reimbursement, maximum reimbursement, and payer-negotiated reimbursements (i.e. insurance company reimbursement) for each specific code.

Please contact the Caribbean Medical Center, 787-801-0081, for any questions about the Charge Master file listed below. Billing department.

660559417_Caribbean-Medical-Center_Standard-and-Negotiated.csv

SHOPPABLE SERVICES FILE:

Shoppable Services is a machine-readable file listing 300 common Shoppable Services provided by the hospital, including some services required by CMS. As identified in the Charge Master file, the Shoppable Services file includes each standard charge, minimum reimbursement, maximum reimbursement, insurer-specific reimbursement, along with consumer-friendly service descriptions.

Please contact the Caribbean Medical Center, 787-801-0081, Billing Department, for any questions regarding the Shoppable Services file.

660559417_Caribbean-Medical-Center_Shoppable.csv