Preparing for the CMS Price Transparency Mandate

Stethoscope sits on top of a stack of money to represent price transparency
CMS hopes that their new price transparency mandate will help people understand their costs surrounding healthcare.

The deadline for implementing price transparency measures is quickly approaching. Healthcare organizations must act now to make sure they comply with these new regulations. Many health systems hope that price transparency measures will just go away. But, given the increasing political and consumer pressure surrounding healthcare costs, it seems more likely that it’s a matter of when, not if, healthcare organizations will be forced to address these pricing challenges.

Organizations that that take steps today to make information readily available to consumers will have a competitive advantage over those that don’t, and they will reduce the risk of financial blowback from non-compliance. Failure to comply with these regulations, scheduled to take effect on January 1, 2021, can result in penalties to the organization of up to $300 per day as well as additional audits and corrective action plans.

Price with Confidence

It is a significant challenge for healthcare organizations to collect and post pricing data in a meaningful way. Before that can even happen, it is important to ensure their pricing structure makes sense and is competitive with other organizations in the area. Consider reviewing existing pricing information across all revenue streams and make careful comparisons with peer organizations.

Post standard charges

The CMS regulation contains two price transparency requirements. First, healthcare organizations must post their entire array of standard charges online in a machine-readable format that is easily accessible from their website. For each item, the following must be included:

  • Gross Charges
  • Discounted Cash Prices
  • Payer-Specific Negotiated Charges
  • Minimum Negotiated Charges
  • Maximum Negotiated Charges

Pricing information should be presented for all patient types, including inpatient, outpatient, emergency, urgent care, professional fee and observation. This leads to large files that easily reach more than two million data points.

Post shoppable healthcare services

The second portion of the regulation requires organizations to publish a pricing document that lists 300 specific shoppable healthcare services. Of the 300 services, 70 have been defined by CMS, and the remaining 230 can be chosen by the organization itself. These services include both inpatient and outpatient care. For each shoppable service, the pricing information from the standard charges document (bullet points above) must be listed. It also must contain any ancillary charges that are usually included for the shoppable service. This includes the cost of supplies, drugs, additional tasks and procedures. Consumers must also be advised of any professional fees that may be billed separately from the facility fees.

Consider a consumer facing tool

Though it’s not required, healthcare organizations should consider implementing a price estimator tool that can interface directly with consumers online. This tool should allow consumers to access accurate estimates for specific services and procedures. In order to be meaningful, it must incorporate co-pay and deductible information specific to the patient to make sure the out-of-pocket estimate is accurate.

Meeting the January 1st deadline will ensure healthcare organizations do not incur any potential non-compliance penalties. Taking these steps to be more patient-centric will increase overall satisfaction and improve your competitive edge in the marketplace.

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