Federal Price Transparency provides insight into cost of medical services for hospital price transparency. The requirements regarding transparency for hospitals, as provided by the Centers for Medicare and Medicaid Services (CMS), are a helpful guide that patients and doctors can access. Ideally, this should translate into better compliance and fewer surprises. However, it is challenging to be fully compliant, as many patients do not understand their out-of-pocket-costs. Why? Because unlike shopping for consumer goods, there are multiple factors governing what healthcare consumers may ultimately pay, specifically in regard to copays, coinsurance, and deductibles. Fortunately, despite the uncertainties and changing guidelines, it is possible to practice compliance by following the below mentioned strategies for better hospital price transparency.
In 2022, Government ramped up enforcement against non-compliant hospitals with respect to hospital price transparency requirements. They did so by levying monetary penalties against two hospitals that failed to fulfill the transparency requirements. How can you reduce the risk of CMS audits and ensure the smooth functioning of your practice?
- Make sure that publicly available information does not contradict the information provided to patients
Since hospitals are required to make a machine-readable file of their pricing along with information on shoppable services accessible to the public, anyone can review for discrepancies. For instance, a well-informed patient can easily cross-check the price of a service as mentioned on the machine-readable file with the services list and flag anything that does not match. CMS permits a patient to submit complaints regarding non-compliance, thus it is imperative to share accurate and complete information.
Not only this, but consumers who receive other information regarding costs, such as an uninsured estimate under the No Surprises Act can cross-reference this estimate with the cost mentioned in your machine-readable file. This all calls for extra vigilance on your part.
- Following the law with precision and supplement with additional pricing information
You may have the best intentions when you create price estimation hotlines or provide phones numbers for customer service, but this does not absolve you from obligations under established guidelines. Hence, it is important to meet the letter of the law even when you are taking these additional steps.
- Respond to CMS to mitigate escalations and penalties
Accused of price discrepancies? CMS allows hospitals to rectify any noncompliance prior to imposing penalties. This is done in the form of warning letters or corrective action plans. CMS is not required to penalize you “immediately”, and you should not only be responding promptly to such outreach but also documenting all your efforts to remedy the situation. This will greatly alleviate the likelihood of having to pay a fine.
Despite notable complexities, hospitals that provide further hospital price transparency have an edge over their competitors in that they are typically able to maintain higher levels of patient satisfaction. Alleviate your billing burdens while simplifying your process with a partner for hospital price transparency. Learn more.
