For decades private and public stakeholders alike have worked to gain hold of ever-rising healthcare costs. As most know by now, an executive order signed by the President in June 2019 directed the Department of Health and Human Services to develop rules requiring hospitals to publish—in a consumer-friendly format—prices “that reflect what people actually pay for services.” The resulting Rule aims to equip healthcare consumers with pricing data, promote consumer empowerment and the ability to shop for healthcare, and, hopefully, to decrease costs.
On January 1 – less than 30 days from today – every hospital in our country is required to begin publishing a list of their standard charges for the items and services they provide to their patients – a virtual shopping list for potential patients to consider as they consider where to purchase their healthcare. CMS’ Final Rule includes both inpatient admission and outpatient departments, with items and services including things such as supplies and procedures, room and board, use of the facility, the services of physicians and staff, and many others.
Hospitals must make their standard charges available through: (1) a comprehensive, machine-readable file; and (2) a consumer-friends list of “shoppable services” – literally allowing health care consumers to make “apples to apples” comparisons from hospital to hospital. With fines of up to $300 per day for every day of non-compliance, hospitals cannot afford not to have their inventory of items and services in order.
By January 1, 2021 everyone covered by this Final Rule should:
- Scrub and display your chargemaster with patient-friendly descriptions
- Analyze claims data to determine high/low procedure charges for all service packages, including bundled charges
- Further analyze claims data to determine high/low charges for individual items and services
- Display de-identified your minimum and maximum payer allowed charges
- Display average allowed charges for each contracted payer
- Provide a backend administrative System for overriding any displayed data and disclaimers
- Create editable patient communications
How can hospitals get this done quickly and efficiently, and maintain the integrity of the list throughout the years go come? Granite GRC’s team of experienced professionals is ready to help you to make 2021 your best year yet. For a free consultation, and with any questions or concerns, please reach out to Jeff Miller, Esq. at (717) 205-8028 or at firstname.lastname@example.org, or to Joette Derricks at (717) 877-5416, or at email@example.com. We look forward to talking with you!
Article written in collaboration by:
Jeffrey B. Miller, Esq, Director-in-Charge and Joette P. Derricks, MPA, FACMPE, FELLOW-AAPC, CHC, CPC, LSSGB, Senior Consultant