23 Nov The Price Transparency Act and What it Means for Hospitals in Puerto Rico
January 1st, 2021 marks a significant date for the Healthcare system across the USA and its territories. As of this date, US hospitals will need to comply with the Centers for Medicare & Medicaid Services (CMS) new hospital price transparency rule. For hospitals to be successful in conforming to this new order, a clear understanding of what is being required and how to provide the information is needed. This new rule calls for facilities to create and maintain a public list of their standard charges, including private payer-negotiated rates, for 300 “shoppable” services. These standard charges are the regular rate established by the hospital for an item or service provided to a specific group of paying patients which includes a variety of types of charges such as:
- Gross Charge
- Payer-specific negotiated charge
- De-identified minimum negotiated charge
- De-identified maximum negotiated charge
- Discounted cash price
Some of the items and services that fall under this rule may include but are not limited to:
- Supplies and procedures.
- Room and board.
- Use of the facility and other items (generally described as facility fees).
- Services of employed physicians and non-physician practitioners (generally reflected as professional charges).
- Any other items or services for which a hospital has established a standard charge.
These public standard charges must be made available by both a machine-readable file that contains a list of all standard charges for all items and services and a consumer-friendly list of standard charges for a limited set of shoppable services. Now in addition to this, each hospital location operating under a single hospital license that has a different set of standard charges must separately make public the standard charges that apply to that location. There will also be required data elements, specific formatting, location and accessibility of the information, and how to update that properly.
Those same points are also included in the consumer-friendly versions of the information, which adds a plain-language requirement making it easier for readability by those that request it. CMS will deem a hospital as having met the requirements for making public standard charges for 300 shoppable services in a consumer-friendly manner if the hospital maintains an internet-based price estimator tool that meets a list of predetermined requirements.
Of course, none of this can be taken lightly. Failure to comply can mean fines, including monetary ones. As an agency within the Department of Health and Human Services (HHS), CMS will use methods to monitor and assess hospital compliance with the requirements which can include, but are not limited to, the following:
- CMS’ evaluation of complaints made by individuals or entities to CMS.
- CMS review of individuals’ or entities’ analysis of noncompliance.
- CMS audit of hospitals’ websites.
Although the future of this rule is still being disputed in the courts, the panorama shows that it will still impact the Hospital Industry. Since compliance is a major characteristic of hospitals to maintain their transparent standards of care for patients, the Healthcare Consulting team at FPV & Galindez is there to provide the support and guidance that your institution needs to thrive in these changing times.
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