“The Association of American Medical Colleges defines price transparency as the readily available information on healthcare service prices that, along with other data, define the value of such services.”
The CMS regulations for true hospital price transparency in medical billing
Hospital price transparency helps Americans know the cost of a hospital item or service before receiving it. As per CMS, starting from January 1, 2021, each hospital operating in the United States was asked to provide clear, accessible pricing information online about the items and services they provide in two ways:
– As a comprehensive machine-readable file with all items and services.
– In a display of shoppable services in a patient-friendly format.
This information makes it easier for patients to compare prices for their shoppable services across hospitals and estimate the cost of care before going to the hospital.
Starting January 1, 2022, the Biden administration has proposed enhanced regulations that would impose significantly higher penalties on hospitals for non-compliance with price transparency rules. Hospitals with more than 550 beds could face penalties of over $2 million per year. This puts even greater pressure on healthcare providers to ensure they are complying with hospital price transparency regulations.
Challenge for healthcare price transparency
Despite its potential benefits, many hospitals have struggled to comply with the new regulations. In some cases, this has resulted in significant fines and other penalties.
Under the CMS regulations, hospitals that fail to publish their standard charges online can be fined up to $300 per day. This can add up to millions of dollars in fines over time, putting a significant strain on hospital budgets. In addition to financial penalties, non-compliance can also damage a hospital’s reputation and erode patient trust. When patients feel that a hospital is not being transparent about its prices, they may be less likely to seek care there in the future.
What measures can providers take to avoid incurring fines?
4 Best practices for hospitals to avoid heavy fines
- Invest in technology
Investing in technology has been a game changer for hospitals. Online price calculators and patient portals are just two examples of the many tools available at the disposal of healthcare providers. These technologies improve patients’ ability to obtain prompt and accurate pricing information, eliminating the need for navigating complex medical billing systems or relying on assistance from multiple staff members.
2. Trained staff
Hospital staff should be equipped to handle patient questions about pricing and direct them to requisite resources for more information. This can help patients feel more comfortable and informed throughout their interaction with the practice.
3. Compliance monitoring
Providers must stay informed about changing payor guidelines, ICD-10, and CPT codes to comply with hospital price transparency regulations. Regular pricing audits help to reduce denials in medical billing, avoid discrepancies, and improve compliance rates. Accurate and accessible pricing information empowers patients to make informed healthcare decisions.
4. Streamline billing process
A streamlined RCM medical billing process starts with patient access and ends when the practice gets paid for the services rendered. By streamlining the billing process, a healthcare provider can reduce billing errors, improve efficiency, and improve patient experience.
Conclusion – Engage an expert to empower your healthcare practices
Hospitals don’t have to navigate the road to price transparency compliance alone. Effective compliance management in the healthcare industry requires more than just empathy, passion, and patient-centered care. Providers must also possess a strong grasp of technology, be adept at integrating new systems, and have a deep understanding of the current healthcare ecosystem in order to work effectively within it. Additionally, rising staffing costs and revenue cycle management process complexities can further complicate matters- negative margins. To address these challenges, healthcare practices should partner with a reliable medical coding and billing solutions provider. This can help them navigate compliance regulations, reduce the risk of penalties, and streamline their medical coding process, allowing them to focus on delivering high-quality care to their patients.
For example, we leverage our AI-based proprietary tool, HealthX 2.0 to analyze the practice’s electronic health records (EHR). This analytical data is presented through visually appealing presentations using Power BI that help identify easy claims and help reduce errors, minimize administrative tasks, and improve efficiency.
Learn how Jindal Healthcare has helped healthcare providers improve their profit margins with end-to-end RCM solutions.