PRICING TRANSPARENCY IS JUST AROUND THE CORNER

PRICING TRANSPARENCY IS JUST AROUND THE CORNER

Are you ready to meet the CMS Pricing Transparency requirements by January 1, 2021?

Hospital pricing transparency is going to be critical and more regulated. If you have started or completed a comprehensive pricing review, do you also have in place the three main components for publishing your hospital’s charges and payor rates?

1. A machine-readable listing of your ChargeMaster with the discounted cash price
2. Multiple machine-readable listings with the required payor specific charge/rate data elements for each contracted payor
3. A consumer-friendly list of 300 shoppable services, including those required by CMS, and the related insurance rates paid for those services

CMS has indicated that failure to meet the Hospital Pricing Transparency provision could result in:

1. Written Warning,
2. Corrective Action Plans, and
3. Monetary Penalties of up to $300/day per hospital

Further complicating the Hospital Pricing Transparency requirements is a separate CMS rule impacting the Inpatient Prospective Payment System (IPPS). Effective for all cost reports ending on or after 1/1/2021, hospitals must include on their cost report the median negotiated payment rate for each Medicare Advantage payor for all MS-DRGs.  

Complying with this requirement is critical as the risk for non-compliance is reportedly possible stoppage in Medicare payments.

About MedCom Solutions

MedCom Solutions can help you be ready for the Hospital Pricing Transparency requirements. We create patented technology and state-of-the-art software to help medical service providers meet rapidly escalating and changing medical billing demands. Our Chargemaster, Pricing, and Compliance solutions have yielded hundreds of millions in net revenue for healthcare providers across the country.

Learn more about our solutions or visit our homepage or contact us today!