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For the purposes of the Hospital Price Report the term “health carriers” refers to insurance companies, health maintenance organizations, non-profits and other companies providing health benefit plans.
Each year the Colorado Hospital Association and the Colorado Division of Insurance are required to publish hospital prices and carrier reimbursement information on a website in accordance with Colorado law (§§ 25-3-705 and 10-16-134, C.R.S.). The General Assembly passed these laws, which require health care providers and health carriers to be more transparent about their prices and reimbursement rates, in order to help consumers make educated choices regarding their health care needs.
The report lists the average reimbursement rates for the twenty-five most common inpatient procedures based upon the most commonly reported diagnostic-related groups. The most common basis for reporting the data to both hospitals and health benefit plan carriers is the Medicare Severity Diagnosis Related Group or “MS-DRG” code developed by the Federal Centers for Medicare and Medicaid Services. If you are unsure as to the MS-DRG code under which you are being admitted, check with your physician.
Hospitals reported their average billed charges to the Colorado Hospital Association, and health carriers reported their average reimbursement rates to the Division of Insurance. The hospital information includes information from both public and private hospitals.
Approximately 15% of the procedures that are reported by hospitals are covered by health benefit carriers regulated by the Colorado Division of Insurance. The reimbursement data represents information reported by these regulated carriers. The remaining 85% of procedures are paid for by the patient, Medicare, Medicaid or another responsible party, such as a self-insured employer and are not included in the reimbursement portion of this report.
Link to the Colorado Hospital Price Report