Pursuant to the 2020 Hospital Outpatient Prospective Payment System (OPPS) rule issued by Centers for Medicare and Medicaid Services (CMS), all UPMC hospital are providing online access to a Machine-Readable file of Items and Services. “Machine-readable” means that the data file can be easily processed by a computer. Consistent with these regulations issued by CMS, this file will be updated at least annually.
For each hospital item or service provided to patients, the Machine Readable File of Items and Services specifies the hospital standard (gross) charge, discounted cash price (for an individual who pays cash), and the minimum and maximum charge that a hospital has negotiated with a third-party payer. Additionally, this file contains payer-specific negotiated charge amounts as required by CMS.
It is important to note that contracts negotiated between hospitals and payers use many different, and frequently unique, reimbursement methodologies. Hospital reimbursements for clinical services, i.e., charges, may be conditionally paid based on other services provided, or bundled into the payment for other services. Reimbursements also may vary due to other negotiated, complex criteria specific to particular payer contracts. Consequently, using the Machine Readable File of Items and Services to conduct comparisons of contracted payment rates for specific line items across payers may not accurately reflect total contracted reimbursement rates.
The links below can be used to access the Machine-Readable File of Items and Services for each UPMC Hospital:UPMC Williamsport Hospital - Machine Readable File