In July 2023, CMS proposed some major price transparency changes with the release of the 2024 OPPS rules. Most notably, the proposed rule changes move to standardize the formatting of the machine-readable files (MRF), increase data accessibility and greater accountability. This can lead to a significant impact on hospitals that are not completely compliant with existing regulations. Even if you believe your organization is 100% compliant today, the proposed changes may expose your hospital to penalties. Let’s examine the proposed price transparency changes and highlight how PMMC is quickly moving to incorporate these changes to help our clients remain compliant.
The CMS’ hospital price transparency laws are in full effect. In addition to requiring hospitals to post pricing data online, these regulations also make it mandatory for facilities to provide estimates to patients upon request and include estimates for ancillary providers as well.
At a time when healthcare consumers expect greater personalization when it comes to receiving price estimates, providers are feeling the pressure to improve price transparency by providing an online patient estimation solution that is engaging, easy to use, and most of all, accurate.
Hopefully your hospital's pricing strategy doesn't sound like this: “Prices were set in cement a long time ago and just keep going up almost automatically.” This was one Chief Financial Officer’s explanation of Chargemaster prices from the controversial 2013 Time Magazine article “Bitter Pill: Why Medical Bills Are Killing Us.” The article highlighted the extreme cases of high prices at hospitals and even called several hospitals (by name) into question. Although some of the findings in the report were later disputed, the article placed hospital pricing under a microscope and reinforced the need for defensible pricing. Automatic price increases might be the traditional route, but the strategy opens itself up to scrutiny, inefficiencies, and a potential loss in net revenue. Because of these factors and the recent emphasis on increased price transparency and defensible pricing, hospitals are moving away from the "across the board" annual gross price increase and towards a modeling approach to predict how charge adjustments impact net revenue. Not only does this give finance a clearer picture of future net revenue, it creates a defensible pricing strategy if prices ever come into question.
There is a lot of discussion about Price Transparency in Healthcare across our country. Many state legislatures are getting involved, including Florida. Recently, Florida Governor Rick Scott announced he will encourage (some might say push) state legislation to require hospitals to post their prices for procedures and services as well as their average reimbursement on the hospitals' websites in early 2016.