CMS Price Transparency rule enforced January 1, 2019. Are you ready?

Price transparency has been a challenge for patients, payers and providers, across the nation. Beginning January 1, 2019, CMS will be enforcing regulations enacted under the ACA requiring all hospitals to be transparent with their standard charges for medical procedures, disclosing them publicly, via the internet. The regulators will be looking, as will your patients — if not already.

Learn more about the benefits of price transparency in
our infographic.

While 29 states have at least one price transparency law in place¹, most of the country fails at complying with this rule². Moving forward, a failure to appropriately adhere to this rule could result in fines and penalties, as well as significant impacts to patient satisfaction and loyalty.

Here are two things you need to know to prepare yourself for price transparency in the new year:

Navigating an audit and defending your lack of compliance is very challenging. Chances are your hospital has already taken some steps to provide a level of accessible price transparency information to address legislative and patient needs. The largest hurdle in the new rule — which many hospitals may not be aware — is that you will now be required to make a list of standard charges, as reflected in its chargemaster, public via the internet, and update it at a minimum of once a year.

With the rule change, the regulators are looking for active, engaged and transparent revenue cycles — and they will see the difference between compliance and complacency.

For example, the definition of posting has been more clearly defined. Be sure your “machine-readable”, online list meets the rule’s requirements; a PDF file isn’t an acceptable format.

Your organization is likely “close” — but you and your organization need to be confident in meeting the requirements for your patients and your compliance efforts.

The patient consumer will continue to expect price transparency when it comes to their healthcare costs. Regulators will likely continue to adapt and modify price transparency rules over time. Be prepared by listening to your patients’ concerns around pricing, payment plans and overall care, and adapt your strategies accordingly.

An external partner can help streamline your patient price estimation and price transparency efforts. Learn more about the importance and impact of price transparency in our recent infographic.

TransUnion Healthcare offers comprehensive solutions to help address your price transparency needs through our Patient Payment Estimation and Price Transparency solutions.

¹ https://www.ncsl.org/research/health/transparency-and-disclosure-health-costs.aspx#Legislation
² https://www.catalyze.org/wp-content/uploads/2017/11/Price-Transparency-and-Physician-Quality-Report-Card-2017_0-1.pdf