Pricing Transparency: Time to Take Action!
As most of us are aware, the Hospital Price Transparency Final Rule (final rule) went into effect on January 1 of this year. The final rule requires hospitals to make public a machine readable file containing a list of the standard charges for all items and services, and to display charges for the hospitals 300 most shoppable services in a consumer-ready format. For the reporting of the standard charges and shoppable services hospitals are required to make public the gross charges, discount cash price, payer specific negotiated charges, and the de-identified minimum and maximum negotiated charges. A compliant Price Estimator Tool can be substituted for the list of shoppable services. Hospitals that do not comply with the final rule face civil monetary penalties of up to $300 a day or $109,500 per hospital per year.
Since January 1st, several groups have conducted studies of hospital compliance with the final rule. Sadly, the results are not encouraging. One study found that 65% of the nation’s largest hospitals were “unambiguously non-compliant” with the final rule. Other studies have found that hospitals are providing consumers with a price estimator tool without including a full list of standard charges, data formats that do not meet the definition of a machine-readable file, and standard change and shoppable services files that do not include all data elements (such as codes for items and services).
Congress is concerned about “troubling reports” of some hospitals either acting slowly to comply with the requirements of the final rule, or not taking any action to date to comply. In a letter to the Secretary of the Department of Health and Human Services (HHS) dated April 13, 2021, the House of Representatives Committee on Energy and Commerce is urging the Secretary to ensure that “HHS conducts vigorous oversight and enforces full compliance with the final rule.” In addition, they have requested a staff briefing on the implementation of the final rule and on the agency’s audit of hospitals’ compliance with the final rule.
Is your hospital in compliance with the final rule? Does your organization want to be singled out AND potentially fined for not being compliant? If the answer is NO to both questions, we can help.
Microscope has a software solution called the AllPayor System that will help bring your hospital into compliance with the final rule. As a bonus, this robust system offers claims and contract management tools that will help you optimize your revenue cycle results.
Article written by Terry Lang
Please contact our Managing Principal of Reimbursement for more information: