Hospital Chargemasters

Overview

Health and Safety Code Section 1339.50 -1339.59 requires HCAI to collect and post a copy of the Chargemaster, a list of 25 common outpatient procedures provided by hospitals, and an estimate of increase in gross revenue due to price increases. The purposes of this statute are to provide patients, health plans and healthcare purchasers with more information about charges for hospital care; and to discourage hospitals from establishing charges that adversely affect private payers and patients.

The Payers′ Bill of Rights still requires each licensed hospital to make a written or electronic copy of its chargemaster available at the hospital′s location or on its website. A hospital that is statutorily classified as “small and rural” is exempt from making its chargemaster available on-site.

Each hospital is required to submit a copy of the Chargemaster, a list of 25 common outpatient procedures provided by hospitals, and an estimate of increase in gross revenue due to price increases annually on July 1. Health facilities licensed as a Chemical Dependency Recovery Hospital or a Psychiatric Health Facility are exempt from these requirements.

Submit Chargemaster

Annually, July 1st, each hospital is required to submit the following:

A copy of its Chargemaster as of June 1st.
A list of its average charges for 25 common outpatient procedures provided by hospitals as of June 1st
an estimate of the percentage change in the hospital’s gross revenue due to any price change during the 12-month period beginning with the effective date of the previous Chargemaster filed.

HCAI has developed an optional reporting form for hospitals to report the list of average charges for 25 common outpatient procedures including instructions for completing the form. Hospitals are encouraged to use the optional form to report the required list of average charges for 25 common outpatient procedures. See Chargemaster Submission Guide for more details regarding each of the required documents.

To help HCAI keep track of submitted files, save files with the following names.

All three documents in one spreadsheet:

“HCAI ID”_CDM_All : Charge description master, estimate of the percentage change and average charges for 25 common outpatient procedures provided by hospitals

Three documents separately:

“HCAI ID”_PCT_CHG : Estimate of the percentage change
“HCAI ID”_CDM : Charge description master
“HCAI ID”_Common 25 : Average charges for 25 common outpatient procedures provided by hospitals

The above documents should be submitted by email to Chargemaster@hcai.ca.gov or by mail in a CD-ROM. Chargemaster submissions must be either Microsoft Excel (.xls) or Comma Separated Value (.csv). Hospitals using Microsoft Excel may submit all required items in a single file, as long as each item is placed in a separate worksheet tab. CD-ROM submission must be sent to the Hospital Disclosure Compliance Unit, 2020 West El Camino Ave Suite 1100, Sacramento, CA, 95833

Late Submission

Health and Safety Code Section 1339.59 and 128770 authorizes HCAI to impose a civil penalty of one hundred dollars ($100) per day for failure to file a timely report. Penalties imposed may be appealed pursuant to current appeals processes provided by Health and Safety Code Sections 128770 and 128775.

Find Hospital Chargemasters

All Chargemasters including current year submissions can temporarily be found on the Open Data Portal. Please exercise caution when interpreting HCAI data. The use of improper assumptions and analytical methods may result in erroneous or misleading conclusions. Conclusions drawn from HCAI data are the sole responsibility of the user.

Explore Chargemaster data on the OpenData Portal

HCAI does not have the authority to intervene between patients and hospitals involving billing issues. If you are experiencing problems or have questions regarding your hospital bill that the hospital is not able to fully address, then it is recommended that you contact a not-for-profit patient advocacy group, such as Health Access California for assistance.