LUTZ BUSINESS INSIGHTS
CMS Finalizes Changes to Help Improve Patient Care Including Price Transparency
PAUL BAUMERT, HEALTHCARE CONSULTING SHAREHOLDER
Of high interest to many hospitals is the requirement for increased price transparency. Previously, the Centers for Medicare & Medicaid Services (CMS) required the posting of standard charges or policies for the public to view upon request. Effective January 1, 2019, CMS has made the requirements more specific. The updated guidelines now require hospitals to post this information in a machine-readable format on a publicly available domain.
Although keeping information up to date on a hospital website may pose an increased burden for hospitals, CMS reports that the goal is for the focus to return to quality patient care with transparency being one of the measures.
To help comply with the new requirements Lutz is providing the following information:
- All hospitals are required to comply
- The published list must include every service and item provided by the hospital based upon the charge description master file in XML, CSV or Excel format
- Website links to pricing comparison data will not fulfill the requirement
- Hospital to determine the definition of standard charges, but gross charges in the charge description master file will comply with the requirements
- Include the item and service description and standard charge, but not the CPT/HCPCs codes, unless receiving permission from the American Medical Association has been received
- APC or DRG amounts will not satisfy the requirement
These charges should be updated at least annually, or more frequently as needed. Below are recommended disclosures on the hospital website for improved patient understanding of the data presented.
- The standard charges are not the patient’s financial responsibility
- Uninsured or underinsured patients may qualify for charity care or financial assistance
- Physician services may or may not be included in the standard charges
Disclaimer language should be added so that patients understand that charges listed are not necessarily their final bill. Below is an example of basic disclaimer language for your consideration:
“This list of charges reflects the standard charges for inpatient and outpatient services provided at _________ (hospital). The hospital’s charges are the same for all patients, but the patient’s financial responsibility for services provided may vary, depending upon payment plans negotiated with individual health insurers as well as reimbursement schedules set forth by public payers such as Medicare and Medicaid. Patients should contact our staff (list name, email, phone number, etc.) for assistance. These charges do not include items or services that may be billed separately for physician services, lab, diagnostic services, etc.”
In order for both patients and hospitals to fully benefit from the requirements of the rule, it is important that hospitals follow through with keeping chargemasters up-to-date and educating staff on pricing and how to have patient financial responsibility discussions.
CMS Finalizes Changes to Empower Patients and Reduce Administrative Burden. August 2, 2018. Retrieved on November 27, 2018 from https://www.cms.gov/newsroom/press-releases/cms-finalizes-changes-empower-patients-and-reduce-administrative-burden
Frequently asked questions regarding requirements for Hospitals to make public a list of their standard charges via the internet. Retrieved on November 27, 2018 from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Downloads/FAQs-Req-Hospital-Public-List-Standard-Charges.pdf
ABOUT THE AUTHOR
PAUL BAUMERT + HEALTHCARE CONSULTING SHAREHOLDER
Paul Baumert is a Consulting Shareholder at Lutz with over 20 years of experience in accounting and consulting for healthcare and nonprofit industries. He specializes in the areas of financial management support services and reimbursement analysis.
AFFILIATIONS AND CREDENTIALS
- Nebraska Society of Certified Public Accountants, Member
- American Institute of Certified Public Accountants, Member
- Healthcare Financial Management Association, Member
- Certified Public Accountant
- Fellow of the Healthcare Financial Management Association
- BSBA, Creighton University, Omaha, NE
- Elkhorn Public School Foundation, President
- Iowa Healthcare Financial Management Association, Past President
- Nebraska Society of Certified Public Accountants Legislation Committee, Chairman
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