Price transparency ‘gets real’ with final ruling – begin preparing for 2021 today

By Kyle Sherseth, CHFP, Vice President, Advisory Services | Posted: 11/19/2019

Price transparency

Health care price transparency took a decidedly real turn on November 15 with announcement of the Trump administration’s final ruling. Despite much debate in recent months over its more controversial aspects, it stands astonishingly intact, sending the industry an abundantly clear message: CMS1 is 100% committed to giving patients the financial details they need to make informed decisions on their health care choices.

Fortunately, and perhaps the biggest reveal, is CMS’ gift of time to comply. With the new regulations set to go into effect on January 1, 2021, the American health care industry has more than a year to get its proverbial ducks in a row, and the date could be pushed out further depending on the inevitable court battle that will result from this ruling. This is very good news, as much of the solution for the next wave of health care price transparency resides in adoption of the latest technology – especially electronic patient estimates – and technology implementation doesn’t happen overnight.

Breaking it down

First, it is important to clarify that CMS’ latest ruling picks up where the 2019 regulation left off. Now, in addition to requiring hospitals to post their Charge Description Master (CDM) list prices to the internet in a machine-readable format, providers will also be required to post in-network and out-of-network negotiated rates for all payor contracts, as well as related discounted cash prices and the max/min negotiated rates. They also provided guidance on the specific CDM fields that need to be included in the machine-readable file going forward. To say the industry is unhappy about publicly publishing proprietary reimbursement information is an understatement and beyond the scope of this blog, however, suffice it to say that access to this information on some level is essential to provide patients with an accurate accounting of their out-of-pocket costs.

Knowing this, of course, is the crux behind CMS’ requirement that hospitals post gross charge and reimbursement rates for 300 “shoppable services,” displaying this information in a consumer-friendly format. Hospitals that deploy web-accessible estimators are exempt from this requirement, which is a smart move on CMS’ part, as estimation technology automatically pulls this information from the CDM and Contract Management systems to tailor out-of-pocket estimates specifically to the patient. Adopting technology to aid patients with their decision-making process will increase patient satisfaction and allow providers to control the flow of communication regarding financial responsibility, while satisfying the 2021 shoppable service requirement.

Prepare for 2021 today

nThrive encourages hospitals to prepare for the upcoming health care price transparency regulations in three ways:

  1. Invest in estimation technology that will allow patients to determine their out-of-pocket costs via your website.
  2. Deploy the latest Contract Management technology to ensure accuracy of patient out-of-pocket estimates and decrease the amount of time to pull reimbursement information into your website CDM.
  3. Review your Chargemaster to ensure the defensibility of your charging structures and pricing strategies.

Choose wisely on vendor partners

We believe the best way to ensure a successful implementation of price transparency initiatives is choosing a full-service vendor that can help you approach the challenge holistically. At nThrive we have the technology and expertise to help your health care organization develop a robust price transparency system that includes:

Get started today

Implementing price transparency initiatives will take time and organizations should begin planning immediately. To learn more on how nThrive can help you respond to the 2021 price transparency requirements, contact us at solutions@nthrive.com or call us at (678) 323-2500 to speak with an nThrive expert.

1Centers for Medicare and Medicaid Services