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/policies/administrative/uw-health-administrative/fiscal-affairs/223.policy

20180129

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UWHC,UWMF,

Policies,Administrative,UW Health Administrative,Fiscal Affairs

Estimated Cost of Medical Service (2.23)

Estimated Cost of Medical Service (2.23) - Policies, Administrative, UW Health Administrative, Fiscal Affairs

2.23

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Administrative (Non-Clinical) Policy
This administrative policy applies to the operations and staff of the University of Wisconsin Hospitals and
Clinics Authority (UWHCA) as integrated effective July 1, 2015, including the legacy operations and
staff of University of Wisconsin Hospital and Clinics (UWHC) and University of Wisconsin Medical
Foundation (UWMF).

Policy Title: Estimated Cost of Medical Service
Policy Number: 2.23
Effective Date: January 12, 2018
Chapter Fiscal Affairs
Version: Revision

I. PURPOSE

To establish a policy and procedure for the provision of accurate estimates of the cost of medical services.
To assure that estimates given are understood to be only estimates and not a final quote. Wisconsin Act
146 entitles patients to the right to good faith estimates of the cost of medical care upon request. Certain
common procedures must be publicly posted. Wisconsin Act 146 also requires all hospitals to disclose
the median billed charges; the average allowable payment under Medicare; and the average allowable
payment from private, third-party payers for the State's top 75 inpatient DRG's and outpatient surgical
procedures. A copy of the document can be found at www.wipricepoint.org and given to patients as
requested. A statement informing consumers that they have the right to receive information regarding
charges and the quality of health care services should be prominently displayed in areas in clinics and
hospitals that are most commonly frequented by health care consumers. A more personalized estimate
can be obtained by contacting any trained and authorized staff. Comparative information on the quality of
care at UW Health may be found on the Wisconsin Collaborative for Healthcare Quality's website at
www.wchq.org.

II. POLICY ELEMENTS

Estimates of the cost of services provided by UW Health may be provided only by trained and authorized
staff. To assure clear communication, all price estimates given will be documented in the Health Link
Price Estimate module and a confirmation letter will be sent to the patient. Written estimates will not be
provided when the requester name is not provided (medical price shopper). All estimates should specify a
range of costs within which the majority of cases fall as well as the average cost, excluding cost outliers.
A single figure may be construed to be a quote. It must be emphasized that the prices given are estimates
only, and are subject to change. Both UWHC charges and UWMF charges are included in the price
estimate, unless the request is for hospital or physician charges only.

Incident-specific letter specifying procedure code(s) and price ranges, inclusive of all hospital and
professional charges.

III. PROCEDURE

A. Revenue Cycle creates templates of common estimates/services in Health Link, based on prior
requests and understanding of organization charging practices and patterns. These estimate
templates can then be used by other trained and authorized staff to provide an estimate to patients
as needed. Templates can only be created or updated by staff within the revenue cycle.

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Price estimate requests for non-templated services must be completed by a Price Line Specialist
within the revenue cycle who can be reached at 608-263-1507. These non-templated estimates
must be developed using the process outlined below:
1. ICD-10-CM and/or CPT-4 procedure codes are required to properly identify the
procedure. When possible, clinical staff should provide this to the person requesting the
estimate. If this information is unavailable, the ICD-10 and CPT-4 codes will be
requested and/or reviewed by UW Health coding staff for accuracy.
2. The Price Line Specialist will use Health Link’s Price Estimate module, and/or the
Business Planning and Analysis SQL Database to determine, from actual case data, the
range of prices for the procedure for the hospital charges. The Price Line Specialist will
use the appropriate professional fees by consulting the appropriate Medical Foundation
fee schedule or contacting UW Health billing staff.
3. The hospital estimate must be expressed as a range of low to high into which the data
indicates a majority of cases fall. The procedure code used to derive the estimate must be
specified. The professional fees must be expressed in terms of a price by CPT code or
range determined by UW Health staff.
4. The estimate will be provided in writing to provide documentation for both parties of the
amount estimated. When there are time constraints, an estimate may be provided orally
but will be confirmed in writing. Written estimates will not be provided when the
requester name is not provided (medical price shopper). A copy of the documentation is
scanned to the hospital's Document Imaging System and stored within the Health Link
Price Estimate module. It must be stated very clearly that the information is an estimate
and is not intended to be a price quote

V. REFERENCES

Wisconsin Act 146

VI. COORDINATION


Sr. Management Sponsor: VP, Revenue Cycle
Author: Patient Access Director
Reviewer(s): Director, Revenue Cycle

Approval committee: UW Health Administrative Policy and Procedure Committee

SIGNED BY

Elizabeth Bolt
UW Health Chief Administrative Officer