The amount hospitals are paid for inpatient care can be estimated with moderate accuracy for patients covered by Medicare, Medicaid, or private insurance.
Using the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project data and Medicare data from 2006, researchers reviewed inpatient charges from more than 1,000 community hospitals in 10 states.
They then applied a “payment-to-charge” calculation that converted a hospital’s charges to an estimated payment for the inpatient care provided.
Study authors stated this calculation is currently the only method available to estimate fee-for-service payment for privately insured hospital stays, which represent a sizable amount of stays for patients younger than 65.
For details, see Smith et al. (2015). Predicting inpatient hospital payments in the United States: A retrospective analysis. BMC Health Services Research, 15, 372. See abstract.