This data is required to be posted online in machine-readable format by the Center for Medicare and Medicaid Services (CMS) Inpatient Prospective Payment System FFY 2019 rule.
The information contained here complies with federal regulations, but healthcare billing is very complex and while standard charges may be compared, hospital “charges” are not the “prices” actually paid by patients or insurers, so this information is virtually meaningless as far as what you will pay for care at Franklin Medical Center.
Description of the information presented here:
Diagnosis Related Groups (DRGs) is the system used by CMS to pay for Inpatient Acute Care Hospital Services for Medicare beneficiaries. It was developed to address the Medicare population, and may not be accurate for use with non-Medicare patient populations.
“Patient Charges” are similar to “list price,” and have little relevance to what is actually paid to FMC. Medicare and Medicaid have government-mandated fee schedules, insurers negotiate prices, and uninsured patients are eligible for significant discounts off these “list prices.”
Charges are accumulated on individual patients based on the goods and services actually received by that specific patient. Many factors (such as severity, health risk factors, etc.) can cause patient charges for patients with similar diagnoses to have different patient charges.
Patient charges included in this report are only for services billed by FMC: hospital inpatient and outpatient, Winnsboro Rural Health Clinic, Surgery Clinic and Urology Clinic.
Services provided by others such as Anesthetists (Riverside Anesthesia), some radiologists (Virtual Radiology) and other providers not employed or contracted by FMC (if you use a non-FMC provider) are not included on this list.
Average charge by DRG for the calendar year 2020 is presented. Please note there may be a very small number of cases in some DRGs, so “average charges” presented may not be a statistically valid number.
Your cost of care at FMC:
The amount you are actually responsible for will vary greatly from the prices presented here based on factors related to your insurance coverage.
If you have Medicare:
- Medicare has many different parts, and not everyone has the same type of Medicare coverage. Medicare will pay for many of your healthcare expenses but not all of them.
- Medicare Advantage (Part C) has different benefits from Traditional Medicare (Part A)
- Diagnosis Related Groups (DRGs) is the method that Medicare uses to determine payment for an acute inpatient hospital stay. Medicare payment to FMC is not based on “patient charges,” and patient charges do not affect the amount that the patient actually owes.
- Special rules apply if you have employer group health insurance coverage through your job or a spouse’s job.
- If you have a supplemental health insurance policy, it may cover some costs that Medicare does not cover.
- The best way to be sure of what your Medicare plan covers is to call 1-800-MEDICARE, or visit the website at www.mymedicare.gov.
If you have Medicaid:
- Medicaid does not use Diagnosis Related Groups (DRGs) to determine payments, so this information does not apply to Medicaid recipients.
- It should be noted that Louisiana Medicaid is developing a payment system similar to Medicare DRGs, but the diagnosis groupings will be different.
- Contact your local Medicaid office at 1-888-544-7996, or visit the Louisiana Department of Health at www.http://ldh.la.gov/ to determine all the factors affecting your financial responsibility.
- Generally Medicaid recipients are not responsible for any portion of the bill, but there are services that may not be covered by Medicaid.
If you have other Insurance:
- Some insurers, but not all, use the Medicare DRG system to calculate payments to FMC.
- Numerous factors such as the type of plan, co-pay, co-insurance, deductible, out-of-pocket maximums, provider network and other specific limitations can affect your financial responsibility.
- Contact your insurance company to understand all of the factors affecting your financial responsibility.
- The prices on this list do not include charges for physician or other professional fees outside of FMC providers.
- The prices on this list do not include any negotiated discounts between your insurance company and the hospital.
If you have no insurance:
- FMC offers discounts to uninsured patients so that they do not pay more than an insurance company would pay, as required by the Affordable Care Act.
- FMC also offers financial assistance to patients who qualify based on their individual financial situation and ability to pay. Please contact FMC business office at 318-412-5290 or 318-412-5412 to determine if you meet the criteria for financial assistance.
The bottom line:
If you are trying to find out how much a procedure or service will cost you, whether you have insurance or not, please call us and let us give you an estimate based on your individual circumstances.