As is usually the case at the beginning of a year, health care providers can expect new rules and regulation changes from the Department of Health and Human Services.
Recently, there has been significant policymaker focus on the issues of price transparency. Here’s a look how some of the changes could impact health care providers and insurance plans.
As we discussed in last week's update, the OPPS rule will require hospitals to provide patients with clear, accessible information about their "standard charges" for the items and services they provide, including through the use of standardized data elements, making it easier to shop and compare across hospitals.
The final rule will require hospitals to make their standard charges public in two ways beginning in 2021:
To ensure that hospitals comply with the requirements, the final rule provides CMS with new enforcement tools including monitoring, auditing, corrective action plans, and the ability to impose civil monetary penalties of $300 per day.
In response to public comments, CMS is finalizing that the effective date of the final rule will be January 1, 2021 to ensure that hospitals have the time to be compliant with these policies.
Shoppable: CMS defines "shoppable" services as a service package
that can be scheduled by a healthcare consumer in advance.
For example, x-rays, outpatient visits, laboratory tests,
or bundled services like a cesarean delivery.
The "Transparency in Coverage" rule would require most employer-based group health plans and health insurance issuers offering group and individual coverage to disclose price and cost-sharing information to participants, beneficiaries, and enrollees up front.
With this information, patients will have accurate estimates of any out-of-pocket costs they must pay to meet their plan's deductible, co-pay, or co-insurance requirements, according to the HHS press release.
If finalized, the rule would require health insurance plans to:
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Industry experts suggest that hospitals and group practices may want to form a “Price Transparency Committee” that can be one aspect of handling price transparency.
They suggest including a small number of people at the highest level to be on the team – to keep it simple.
Consider using the American Hospital Association’s Principles for Price Transparency to form the task force, if you have not already done so. Within the task force, there should be a leader from the revenue cycle, chargemaster analyst, managed care, and business & data analytics, as well as a physician leader.
One of the top duties of a team would be to determine what price transparency means to the organization.
Next, look at the requirement, which is proposing that you put 300 machine-readable shoppable services on your website. 70 of those are pre-selected by CMS, so you’ll need to look at those 70 services listed and determine whether you provide them.
For a fact sheet on the Transparency in Coverage Proposed Rule (CMS-9915-P), please visit:
CMS - Transparency in Coverage Proposed Rule
If you haven't already read last week's post, you may want to check out News - Latest Rules & Legislative Updates. It provides additional summaries on issues pertaining to price transparency, health IT and the Final Rule from the Centers for Medicare & Medicaid Services regarding the Medicare Physician Fee Schedule (MPFS).Like what you see? Be sure to subscribe to Revenue Cycle Matters for healthcare billing best practices and industry tips!