Florida Regulations 59A-3.256: Price Transparency and Patient Billing
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(1) Website. Each hospital shall make available to patients and prospective patients price transparency and patient billing information on its website regarding the availability of estimates of costs that may be incurred by the patient, financial assistance, billing practices, and a hyperlink to the Agency’s service bundle pricing website. The content on the hospital’s website shall be reviewed at least every 90 days and updated as needed to maintain timely and accurate information. For the purpose of this rule, service bundles means the reasonably expected hospital services and care provided to a patient for a specific treatment, procedure, or diagnosis as posted on the Agency’s website. In accordance with Florida Statutes § 395.301, the hospital’s website must include:
(a) A hyperlink to the Agency’s pricing website upon implementation of the same that provides information on payments made to the facilities for defined service bundles and procedures. The Agency’s pricing website is located at: http://pricing.floridahealthfinder.gov;
(b) A statement informing patients and prospective patients that the service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual costs will be based on services actually provided to the patient;
(c) A statement informing patients and prospective patients of their right to request a personalized estimate from the hospital;
(d) A statement informing patients of the hospital’s financial assistance policy, charity care policy, and collection procedure;
(e) A list of names and web addresses of health insurers and health maintenance organizations (HMO) contracted with the hospital as a network provider or participating provider;
(f) A list of names and contact information of health care practitioners and medical practice groups contracted to provide services within the hospital, grouped by specialty or service; and,
(g) A statement informing patients to contact the health care practitioners anticipated to provide services to the patient while in the hospital regarding a personalized estimate, billing practices, and participation with the patient’s insurance provider or HMO as the practitioners may not participate with the same health insurers or HMO as the hospital.
(2) Estimate. The hospital shall provide an estimate upon request of the patient, prospective patient, or legal guardian for nonemergency medical services.
(a) An estimate or an update to a previous estimate shall be provided within 7 business days from receipt of the request. Unless the patient requests a more personalized estimate, the estimate may be based upon the average payment received for the anticipated service bundle. Every estimate shall include:
1. A statement informing the requestor to contact their health insurer or HMO for anticipated cost sharing responsibilities,
2. A statement advising the requestor that the actual cost may exceed the estimate,
3. The web address of the hospital’s financial assistance policies, charity care policy, and collection procedures,
4. A description and purpose of any facility fees, if applicable,
5. A statement that services may be provided by other health care providers who may bill separately,
6. A statement, including a web address if different from above, that contact information for health care practitioners and medical practice groups that are expected to bill separately is available on the hospital’s website; and,
7. A statement advising the requestor that the patient may pay less for the procedure or service at another facility or in another health care setting.
(b) If the hospital provides a non-personalized estimate, the estimate shall include a statement that a personalized estimate is available upon request.
(c) A personalized estimate must include the charges specific to the patient’s anticipated services.
(3) Itemized statement or bill. The hospital shall provide an itemized statement or bill upon request of the patient or the patient’s survivor or legal guardian. The itemized statement or bill shall be provided within 7 business days after the patient’s discharge or release, or 7 business days after the request, whichever is later. The itemized statement or bill must include:
(a) A description of the individual charges from each department or service area by date, as prescribed in subsection 395.301(1)(d), F.S.;
(b) Contact information for health care practitioners or medical practice groups that are expected to bill separately based on services provided; and,
(c) The hospital’s contact information for billing questions and disputes.
Rulemaking Authority 395.301 FS. Law Implemented Florida Statutes § 395.301. History-New 2-19-18.
Terms Used In Florida Regulations 59A-3.256
- Charity: An agency, institution, or organization in existence and operating for the benefit of an indefinite number of persons and conducted for educational, religious, scientific, medical, or other beneficent purposes.
- Guardian: A person legally empowered and charged with the duty of taking care of and managing the property of another person who because of age, intellect, or health, is incapable of managing his (her) own affairs.
(b) A statement informing patients and prospective patients that the service bundle information is a non-personalized estimate of costs that may be incurred by the patient for anticipated services and that actual costs will be based on services actually provided to the patient;
(c) A statement informing patients and prospective patients of their right to request a personalized estimate from the hospital;
(d) A statement informing patients of the hospital’s financial assistance policy, charity care policy, and collection procedure;
(e) A list of names and web addresses of health insurers and health maintenance organizations (HMO) contracted with the hospital as a network provider or participating provider;
(f) A list of names and contact information of health care practitioners and medical practice groups contracted to provide services within the hospital, grouped by specialty or service; and,
(g) A statement informing patients to contact the health care practitioners anticipated to provide services to the patient while in the hospital regarding a personalized estimate, billing practices, and participation with the patient’s insurance provider or HMO as the practitioners may not participate with the same health insurers or HMO as the hospital.
(2) Estimate. The hospital shall provide an estimate upon request of the patient, prospective patient, or legal guardian for nonemergency medical services.
(a) An estimate or an update to a previous estimate shall be provided within 7 business days from receipt of the request. Unless the patient requests a more personalized estimate, the estimate may be based upon the average payment received for the anticipated service bundle. Every estimate shall include:
1. A statement informing the requestor to contact their health insurer or HMO for anticipated cost sharing responsibilities,
2. A statement advising the requestor that the actual cost may exceed the estimate,
3. The web address of the hospital’s financial assistance policies, charity care policy, and collection procedures,
4. A description and purpose of any facility fees, if applicable,
5. A statement that services may be provided by other health care providers who may bill separately,
6. A statement, including a web address if different from above, that contact information for health care practitioners and medical practice groups that are expected to bill separately is available on the hospital’s website; and,
7. A statement advising the requestor that the patient may pay less for the procedure or service at another facility or in another health care setting.
(b) If the hospital provides a non-personalized estimate, the estimate shall include a statement that a personalized estimate is available upon request.
(c) A personalized estimate must include the charges specific to the patient’s anticipated services.
(3) Itemized statement or bill. The hospital shall provide an itemized statement or bill upon request of the patient or the patient’s survivor or legal guardian. The itemized statement or bill shall be provided within 7 business days after the patient’s discharge or release, or 7 business days after the request, whichever is later. The itemized statement or bill must include:
(a) A description of the individual charges from each department or service area by date, as prescribed in subsection 395.301(1)(d), F.S.;
(b) Contact information for health care practitioners or medical practice groups that are expected to bill separately based on services provided; and,
(c) The hospital’s contact information for billing questions and disputes.
Rulemaking Authority 395.301 FS. Law Implemented Florida Statutes § 395.301. History-New 2-19-18.