Chargemaster

The chargemaster is a hospital’s master list of prices for every item and service it provides. Those prices are set internally and bear little relationship to cost or to what anyone actually pays.

Who pays what, in practice:

• Insurers pay a negotiated rate, usually a fraction of chargemaster.
• Medicare and Medicaid pay set rates, lower still.
• Uninsured patients get billed at chargemaster — the highest number in the building.

That last line is the whole reason this term matters. The bill an uninsured New Yorker receives is the list price, and New York law then says that patient often shouldn’t pay most of it: below 200% of the federal poverty level, no out-of-pocket charges at all; between 201% and 300%, no more than 10% of the Medicaid rate; between 301% and 400%, no more than 20%.

Federal price transparency rules require hospitals to publish machine-readable files of their standard charges and negotiated rates. The files are unwieldy, but they’re public, and for a planned procedure they’re the only place the real numbers live.

If you’re holding a bill built on chargemaster rates, the first move isn’t payment — it’s an itemized bill and a financial assistance application.

In New York: the chargemaster figure is what an uninsured patient is billed and almost never what they owe. Public Health Law 2807-k caps the charge at zero below 200% of the federal poverty level, at 10% of the Medicaid rate to 300%, and at 20% to 400%. Hospitals must also publish machine-readable files of their standard and negotiated prices, which is the only public place the real numbers live. If a hospital refuses to discuss the cap, the state Attorney General’s health care helpline takes the complaint at 1-800-428-9071. How to invoke the cap.

Also called: charge description master, CDM, list price. Reference: Chargemaster on Wikipedia — general definition, not New York specifics.