Well, 2019 has arrived and folks can’t stop talking about watching Bird Box over the holidays. I’ll admit, I lost my appetite for such apocalyptic entertainment after watching countless hours of the Walking Dead only to give up halfway through with no desire to see how it ends (unlike my still weekly contemplation on the ending of Lost). Sorry, I get carried away sometimes. We’re not here to encourage you to do the Bird Box challenge. Just the opposite. We want to remove the blindfold and talk to you about healthcare billing and the changes to price transparency that have evolved as we enter a new year.

Challenges

The top concerns the Centers for Medicare and Medicaid Services (CMS) are looking to address this year and going forward include:

  • Surprise out-of-network bills
  • Surprise facility feeds
  • Surprise ED fees
  • Chargemaster data that isn’t helpful

Updated CMS Rule

The new CMS rule that went into effect on January 1, 2019 includes requirements that hospitals must publish a list of standard charges. On October 1, 2018, CMS stealth released a FAQ document and most hospitals are only now noticing it. In this FAQ, CMS clarified that ALL charges must be published online. Here’s the important change directly from the document.

Beginning on Jan. 1, 2019, the federal government will require each hospital to post its “standard charges” on the hospital’s website in a “machine readable” format.

These changes might seem minor, but, they present large challenges. One such challenge is the requirement to update public price lists at least annually and to include all items and services provided by the facility.

The agency also stated, “CMS encourages hospitals to undertake efforts to engage in consumer-friendly communication of their charges to help patients understand what their potential financial liability might be for services they obtain at the hospital, and to enable patients to compare charges for similar services across hospitals.”

Final Thoughts

It is an interesting time in healthcare as you have organizations that will need to compete by providing choice and transparency to their customers. Consumers are pushing healthcare evolution and it will be interesting to see the strides taken in 2019. What remains to be seen is how this new requirement will ultimately be enforced. You can imagine payers don’t want to necessarily divulge the information, so cooperation will be critical.

The following quote from CMS.gov sums up the new policies nicely.

“The policies in the IPPS/LTCH PPS final rule further advance the agency’s priority of creating a patient-centered healthcare system by achieving greater price transparency, interoperability, and significant burden reduction so that hospitals can operate with better flexibility and patients have what they need to be active healthcare consumers.”

In talking with healthcare organizations, we hear that they struggle with providing price transparency. It’s often a complex and manual process that ends up resulting in frustration and low patient satisfaction. Additionally, there will have to be improved alignment between providers and payers, which historically hasn’t been great. To gain trust, both parties will have to work through the disparities to create a better perception of prices.

Wind River Financial is available to help your organization provide greater transparency and assist with your revenue cycle management needs. Please let us know how we can help. In the meantime, you can also read about our brand new approach to propensity-to-pay scoring.