CMS Proposed Rule Requirements to Improve Hospital Price Transparency - Part 1

CMS is changing it up for revenue cycle teams with a 2019 IPPS proposed rule that applies to about 3,300 acute care hospitals.

CMS is changing it up for revenue cycle teams with a 2019 IPPS proposed rule that applies to about 3,300 acute care hospitals. As these changes could improve payment systems, there are 10 key take-aways to see what could impact revenue cycle initiatives and processes.

ClaraPrice anticipated these kind of changes were coming soon in regards to hospital price transparency.

  • The rule requires hospitals to publish a list of their standard charges online and in a machine-readable format. Hospitals are currently required to make this information publicly available or available upon request.
  • As part of the rule, CMS put out a request for information to better understand what stops providers from giving patients sufficient price information and how price transparency can be improved.

We are seeking information from the public regarding barriers preventing providers from informing patients of their out of pocket costs; what changes are needed to support greater transparency around patient obligations for their out of pocket costs; what can be done to better inform patients of these obligations; and what role providers should play in this initiative.

Here’s the link to the entire rule and where to submit comments and ideas from revenue cycle teams.

Next Generation Tools Are Coming Soon

ClaraPrice has developed an accurate on-demand price estimating tool that revenue cycle stakeholders are beta-testing with their patients. Key features help hospital finance teams engage with patients early on about the cost of care case-by-case.

Founder Sarah Soisson explains how customized price estimates from hospitals are driving design of next generation of tools for revenue cycle teams and the public:

RCM bill using DRGs for every patient stay in a hospital. Our proprietary formula that creates these bill estimates is based on the latest CMS data and conditional factors provided by the patient.

When using our tool, the public will have a clear big picture of what their hospital stay would cost, location by location. After discharge, the tool helps finance reps explain the complex bills to patients especially when complications occurred. Posting static price lists just don’t educate the public on what to expect to be billed when they check in to a hospital.”

Will Publishing the Chargemaster Pricing Help the Public?

The Proposed Rule takes Section 2718(e) a step further, and provides that beginning January 1, 2019, CMS will update the guidelines to require hospitals to make available a list of their current standard charges via the Internet in a machine readable format, which requirement a hospital may satisfy by publishing its chargemaster (i.e., a hospital’s comprehensive list of services and charges billable to a hospital patient). In addition to the publication requirement, the Proposed Rule further requires hospitals to update the standard charges they publicize at least annually.

Recently, some states, such as California and Colorado, have also taken steps to promote hospital price transparency. Under California’s “Payers’ Bill of Rights,”[2] California hospitals are required to either post an electronic copy of the charges for its services on the hospital’s website or make a written or electronic copy available at the hospital’s location. Under Colorado law,[3] a healthcare provider must make available to the public, either electronically or by posting on the provider’s website, the healthcare prices of at least the 15 most common services rendered by the provider. Nevertheless, despite the move toward transparency at the state level, many states still lack extensive hospital price transparency statutes.

Read more here.