ClaraPrice is the solution to the Price Transparency Executive Order

Current State of Revenue Cycle Challenges in Meeting Price Transparency Requirements

Posted by ClaraPrice on December 20, 2018

Recent key discussions in Revenue Cycle circles centers on the consumer demand for price transparency and patient-focused engagement initiatives that work so far to prepare for the Proposed Rule change. CMS announced earlier this spring about shifts in price-sharing policy that hospitals and providers need to plan for this year, in order to meet requirements by 2019.

At the National Level

U.S. Senator and doctor Bill Cassidy (R-LA) released a white paper in May that served as a wish-list and proposal of ideas to make healthcare affordable.

Patients can and should have a larger say in how care is delivered and how much they are willing to pay. Currently, the health care system lacks tools found in a free market economy. When buying school supplies, getting an oil change, or shopping for groceries, the price and quality of the product or service is known before purchase. Not so in health care. As a result, the current system isn’t open, accountable, or responsive to the needs of patients. Instead, it is expensive, bloated, and delivers mixed results. Prices for health care services have continuously risen, despite flat or decreasing demand. A way to lower prices and return power to patients is by expanding the use and usefulness of health savings accounts (HSAs) and requiring price transparency.

The Lown Institute sifted through his vision with these comments:

For patients to truly be “empowered,” we need to not only demand price transparency, but have a better method of enforcing transparency. Currently, patients have no recourse if a hospital won’t tell them what a procedure costs, or if insurers negotiate a much higher rate than expected. Even if patients ask for the “cash” rate, they will likely have a hard time getting a price estimate. And this is just for elective procedures! It’s not possible to “shop around” when you need a certain procedure or test immediately to save your life.

Obstacles that hospital revenue cycle teams face with proposed price transparency requirements are surfacing, since bundled pricing and direct contract pricing are in the mix of challenges.

Other experts have documented the variability in the total price of a medical episode of care. As a result, information on the predicted price for the treatment of an illness, injury, or condition has become all the more important for patient-consumers.

Read more here.

State-wide Solutions

Many state-wide models show promise and are working so far for hospitals implementing patient-engagement strategies.

Read: How Maryland hospitals can help patients lower bills and save money

Challenges at IDNs Prioritizing Patient Engagement

Payment solution experts working with overwhelmed revenue cycle teams explain:

“If they are satisfied [with the billing process], they are 74 percent likely to pay in full and 90 percent likely to come back to an organization for service. If they aren’t fully satisfied only 33 percent paid the bill in full,” said Mr. Hanson.

“[Bill pay in healthcare] has been so complex that people throw up their hands and don’t know what to do,” explained Mr. Gehrke. “In addition, some patients don’t promptly pay their bill because they question its accuracy.”

“The upside of consumerism is that it allowed consumers to make more informed decisions … But it has also really challenged the revenue cycle stream,” said Mr. Hanson.

Read more here.




ClaraPrice provides individualized cost estimates for inpatient hospitalizations, empowering patients to prepare financially before, during, and after a medical event.

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