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Hospital Charges For Outpatient Cancer Care Highly Variable, Medicare Billing Records Show

(Johns Hopkins Medicine) Feb 20, 2018 - An analysis of recent Medicare billing records for more than 3,000 hospitals across the United States shows that charges for outpatient oncology services such as chemo infusion or radiation treatment vary widely and exceed what Medicare will pay by twofold to sixfold.

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Winston Wong, PharmD (Posted: March 13, 2018)

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Hospitals will charge whatever they want to charge. The real question is what are they paid? Medicare reimburses from the DRG. Most payers will pay something based upon the DRG rate. Very few will pay charges, or even a percentage of charges. yes there are some exceptions, but even then, there are limits. So why do we look at the charge numbers?

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Thomas Marsland, MD (Posted: March 01, 2018)

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Billing and payments for medical services are a complex, confusing world. There are billed charges which have no bearing on reality. Providers, both hospitals and practitioners, often have charges that are astronomical. No one expects to get "billed" charges. Private payers have contracts which define what they will pay for a given service. Patients are responsible for what their policy requires in terms of co-pays and deductibles. Medicare has fixed fee schedules (price controls ??) with patients responsible for 20% of the allowable on the part B side but 20% of charges on the part A side. So this is where this report hits home. In the hospital setting the amount patients pay may very well vary by huge amounts depending on hospital Part A charges. Agree that there clearly needs to be at least more transparency in terms of patients' payment and possibly some legislation to standardized charges for a given procedure or service. All of which really has little to do the the real, true cost of providing these services.

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