Price Transparency Complexities

Understanding patient first billing
October 24, 2022

Price Transparency complexity requirements continue to loom. 

Let’s start by understanding some key takeaways as we sift through the pricing transparency complexities. 

  • A vast majority of guidelines included in the price transparency rule could cause varied findings. 
  • The healthcare industry is still adapting to these laws and is very slow to change. 
  • RCM leaders need to have a solid understanding of the laws and regulations in order to ensure proper adherence. 

According to a recent report, we are starting to see positive trends in regard to hospitals adopting the law.  The reporting shows 76% of healthcare hospitals have posted a machine-readable file, 65% have posted a machine-readable file with negotiated rates, and 63% have posted a machine-readable file with cash rates. Learn more about machine-readable files.

CMS mandates that hospitals follow strict guidelines to be fully compliant. 

Hospital websites must vividly show the placement of the patient estimate tool, along with machine-readable files, and most importantly the use of plain language (a language that patients can easily understand). These 3 guidelines are imperative to be fully compliant. 

Unfortunately, due to the vast amount of guidelines included in the rule, it can lead to different estimates and adherence based on differentiating factors. 

One of the factors we are seeing as a problem is the lack of automation which is straining hospitals.

We are able to see the first rounds of data that have been collected and published showing infiltration in other parts of the industry as well. As the adaptation of these current laws and regulations increase data shows that it will inspire positive changes. 

Some of these changes are transparent contracting and less variability in pricing. 

As we know the health industry is slower to adapt to changes, however by moving the needle closer to fair prices of services we will be able to see these positive changes take place in time. 

The higher percentage of compliance the closer we are to empowering patients to understand how much their healthcare services will cost. This also eliminates negotiating new rates.

There are a lot of resources available for RCM leaders looking to get a better understanding of the laws and regulations. This will allow you to understand where your organization should focus your efforts, time, and resources. In 2023, CMS expects more changes to come.

Comments are closed.