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Price Transparency Requirements: Quick Answers to Your Frequently Asked Questions

Magnifying glass hovering over words "Price Transparency"

Healthcare consumerism and price transparency represent a constant struggle to our industry. With the heightened attention, this has definitely become top of mind for many healthcare providers. The new mandate takes effect on Jan. 1, 2021, and many organizations are challenged by the information and where to begin.

Below are some of the most frequently asked questions regarding price transparency compliance in the market today.

What do the new provisions entail?

Within the mandate required of acute-care facilities, there are two defined provisions designed to more clearly make pricing visible to consumers. They include:

  1. Providing 300 shoppable services in either a file or patient-acing estimator. There are 70 CMS-specified services that must be included in this 300, in addition to another 230 the hospital can select. All ancillary services offered at the facility must also be accessible to the patient.

  2. Making a machine-readable, hospital standard charge file available that includes gross charges, payer-specific negotiated rates, cash prices, and the highest and lowest negotiated rate.

What does my organization need to do now to be compliant by Jan. 2021?

CMS estimates roughly 150 hours of in-house development time per facility will be needed to get a system in place to address the two provisions outlined above.1 However, this doesn’t consider the time it takes to compile and organize the data — from various, disparate sources. Developing an internal solution will also depend on staff capacity and organizational priorities.

As an alternative, many healthcare organizations are currently working (or looking to partner) with a third-party to address the price transparency mandate. For many, aligning with a partner — perhaps one already in place for patient payment estimation — makes better sense.  If you do go this route, be sure to get on implementation calendars soon to ensure you have adequate time to be up and running prior to the deadline. Whatever path you choose to be complaint, your organization should start working on efforts now.

Keep in mind that many technology partners will only be able to support Part 1 (shoppable services) of the mandate. The TransUnion Healthcare technology will satisfy the full mandate.

Why is being compliant so important?

Patients expect to have pricing information readily accessible so they know out-of-pocket expenses in advance of care. The price transparency mandate is an extension of consumerism and will only amplify as competition from non-traditional healthcare providers (i.e. retail, virtual, and others) expand. Not only is compliance important to meeting patient expectations, but it may help improve patient satisfaction. Also, there’s a significant cost in not being compliant — up to $300 per day per facility, up to a maximum of $109,500 annually.1 Given how competitive the healthcare market can be, you want to be sure your organization stacks up to other hospitals and health systems in the area. When patients have a choice of where to go, transparency around pricing and having accessible options around costs and payments may be the difference.

Learn more about our online patient estimation tool and other ways your organization can prepare for price transparency.

Sources:
1https://www.federalregister.gov/documents/2019/11/27/2019-24931/medicare-and-medicaid-programs-cy-2020-hospital-outpatient-pps-policy-changes-and-payment-rates-and

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