What is the Price Transparency Final Rule?
Price transparency is an over-simplified term. While the OPPS Price Transparency Final Rule (CMS-1717-F2) marks an escalation by regulators to influence a consumer-friendly (and familiar) experience, there is much more opportunity to make patient engagement truly “friendly.”
We know consumers overwhelmingly want to understand the cost of healthcare services, prior to services being performed. Transparency, beyond being regulatory requirement, is a significant improvement to the patient journey - benefiting not just the patient but the provider, which typically sees improved collections and patient satisfaction.
Want to get started? Connect with our team and evolve the patient experience to a seamless consumer experience today!
Seeing Through Price Transparency
The final rule around price transparency isn’t designed to be a final solution.
Vanessa Carter, Pre-Service Center Manager at St. Joseph's/Candler, discusses how they use Experian Health Patient Financial Advisor to provide patients with estimates for services before their visit.
Overview of the Final Rule requirements
The final rule mandates that hospitals must publish the following by January 2021:
Consumer-friendly, searchable list displaying the payer-specific rate for 300 shoppable services
"Shoppable" is defined by CMS as a service that can be scheduled in advance. CMS has already specified 70 services. If you want to read more about the final rule or view the CMS list of 70 shoppable services, click here. Shoppable services can be found on page 190, Table 3.
A comprehensive machine-readable file for “Items and Services” offered by the hospital
The standard file must include:
- Gross charges
- Cash price for self-pay
- Payer-specific negotiated charges
- De-identified minimum/maximum negotiated charges
Patient Estimates
User-friendly, web-based estimates of authorized services for patients before or at the point-of-service.
Patient Simple
Secure online portal, giving patients the 24-7 control they’re looking for over their healthcare accounts.
Eligibility
Experience fewer payment delays, less confusion, and minimal need for follow-up with POS eligibility solutions.
Patient Financial Advisor
Offer real time estimates and secure payment methods with your patient's benefit information, payer rates and provider pricing in mind.
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