Shoppable Services/Estimate of Potential Charges
Effective January 1, 2019, in an effort to “improve the transparency of hospital charges”, the Center for Medicare and Medicaid Services (CMS) has mandated that all facilities participating in the Medicare and Medicaid programs “make public a list of their standard charges” via the internet [CMS1694-F]. Further, Santa Clara Valley Medical Center is happy to provide our Guest Estimate function in order to provide for our patients the ability to calculate an estimate of potential charges and patient liability for the most common 300 shoppable services as required by CMS and the President’s Executive Order.
The County of Santa Clara Health System gladly supports this effort and is therefore providing this information to our patients by posting our price file for both facility and professional charges for our Santa Clara Valley Medical Center campus on this site.
In addition, in compliance with CMS Outpatient Prospective Payment System Policy [CMS-1717-F2, Doc Citation 84 FR 65524], we have provided a machine-readable file which includes the following information regarding services provided at Santa Clara Valley Medical Center:
- Gross charges
- Payer-specific negotiated charges
- Discounted cash (self-pay) prices
- De-identified minimum negotiated charges
- De-identified minimum and maximum charges
STANDARD CHARGE FILE
Santa Clara Valley Medical Center Guest Estimator link
This is tool provides an estimate of potential charges ONLY, based upon the information our guest has provided, on the date that the estimate was created. It is not intended as a comprehensive list of charges or a final liability or payment agreement between Santa Clara Valley Medical Center and the account guarantor.
When services are provided there may be additional charges for supplies, medications and other clinical services as ordered by the guest’s physician. VMC reserves the right to modify these charges in accordance with organizational policies. This estimate does not represent a guarantee of these prices for services on the date services are rendered.
The total charges listed by the Guest Estimator, for a procedure or encounter, may not necessarily represent the total payment expected by Santa Clara Valley Medical Center. The expected payment amount may vary based upon updated contractual arrangements between Santa Clara Valley Medical Center and the various payors, the insurance plans in which the patient is enrolled and other special programs for which the guest may apply and be found eligible for.
If our guests are unable to calculate the estimate using this tool, they are encouraged to contact the Revenue Integrity Department at (408) 885-6884 or via email at [email protected] for assistance.
The Price File, also known as the Charge Description Master (CDM) consists of two master lists of charges related to all services including professional fees, supplies, devices, vaccines, radiopharmaceuticals, and room accommodation charge codes for inpatients and outpatients of Santa Clara Valley Medical Center. There are currently two Price Files in use at Santa Clara Valley Medical Center.
- The Hospital Billing (HB) Price File contains all facility related charges.
- The Professional Billing (PB) Price File contains all of the professional service related charges.
Together, these two Price Files constitute the Charge Description Master (CDM) at Santa Clara Valley Medical Center.
The Price File contains following elements:
Variable prices may be present for services such as Reference Lab testing, implanted devices and items/services governed by other contracted rates. These prices may not be available for listing in the CDM since billed charges are based upon the charges invoiced by the contractor to Santa Clara Valley Medical Center at the time the service is provided.
Pharmaceutical prices listed are acquisition cost based. These costs may vary depending upon many factors such as date purchased and supplier. The patient may, therefore, see multiple prices for what appears to be the same medication. In practice, depending upon the dosage ordered by the provider, a patient may see multiple units of a single medication listed on a claim. The total of these units represents the total dosage provided to the patient. Due to these variances, we recommend that our patients contact the Santa Clara Valley Medical Center Pharmacy department directly for the most accurate estimate based upon the providers medication orders.
COVID-19 DIAGNOSTIC LABORATORY TESTING
In accordance with the Families First Coronavirus Response Act (FFRCA), the Coronavirus Aid Relief and Economic Security Act (the CARES Act) and other healthcare pricing transparency regulations, related to Coronavirus 2019 (COVID-19), the County of Santa Clara Health System is providing this list of laboratory testing service prices. The test performed will depend upon the test ordered by your physician.
Please note that items appended with an “*” and number are tests performed by an outside reference lab. These prices are set by the outside laboratory and are charged as a “pass through” charge at no additional cost to the patient or payor.
COVID-19 Tests Price File
TOP 25 DRGS
For your information, we have also provided a list of average total charges for our Top 25 DRGs (Diagnosis Related Groups)
Santa Clara Valley Medical Center Top 50 DRGs
Individual departments within Santa Clara Valley Medical Center may generate charges through an electronic charge or order communication system. Most charging information for a patient admission or encounter originates from the CDM. The charges, charge descriptions, and all codes attached to a line item in the CDM, flow through electronic systems to Patient Business Services (PBS), where corresponding claims are generated. The claims may be edited before submission to the appropriate payors based upon contractual terms.
The total charges listed for a particular encounter or admission may not necessarily represent the total payment expected by Santa Clara Valley Medical Center. The expected payment amount will vary based upon contractual arrangements between Santa Clara Valley Medical Center and the various payors, the insurance plan in which the patient is enrolled and other special programs for which the patient may apply and be found eligible for.
Should a patient require financial assistance or advice, they are encouraged to contact a Financial Counselor at (866) 967-4677 for direction.
Should a patient wish to obtain an estimate of charges for a visit or procedure, they are encouraged to contact the Revenue Integrity Unit at (408) 885-6884 or via email at [email protected] for assistance.
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