How Can Physicians Keep Their Practices Compliant With The Price Transparency Rule?

The newly introduced ‘Hospital Price transparency Rule’ is regarded as a gift to the Americans. Because it was the most anticipated rule to ensure the maximum transparency in the patients and medical bills.

According to this rule, proposed by The Centers for Medicare and Medicaid Services. Healthcare facilities across the United States are bound to publish the exact prices. Which they negotiate with the insurance companies for certain healthcare services and procedures. Before the implementation of this rule, all these prices were kept secret resulting in confusing medical bills. This rule is expected to bring the sorely needed transparency into the U.S. healthcare system. Which will ensure the availability of quality healthcare services at competitive prices.

The basic purpose of this rule is to enable patients to make well-informed decisions for receiving treatment from a healthcare facility. The lack of awareness among patients, that how much the medical procedure will cost, they are going to undergo most of the time results in unaffordable copays and high deductibles. That can hold patients back from paying their dues. Eventually, physicians lose millions of dollars annually. The majority of the patients complain about the price discrepancies after they receive a medical bill.

National Public Radio (NPR) brought a similar case of one man in Florida into the light. According to this, the victim underwent CT scans of his abdomens from two different facilities. Shockingly he receives two different bills for similar scans. Hold on! It wasn’t a minimal difference. Details might shock you. One cost $268, while the other cost $8,897. This huge difference for the same medical procedures had stirred a debate on social media. It’s just a single example. The US news portals are filled with the stories of such victims. However, finally, it seems like the sufferings of patients regarding price transparency issues are going to end.

Related Article: Analyze Payment Variances & Save Your Healthcare Practice From Financial Loss 

Key Provisions of Transparency Rule

The new CMS rule intends to put an end to this kind of price discrepancy.

  • According to this rule, hospitals are required to make a comprehensive list of 300 shoppable services public. For example, these services are included: knee replacements or x-rays, along with the complete details of the minimum and maximum costs. Furthermore, this information must be presented in a consumer-friendly manner, fulfilling all standards of accuracy and specificity.
  • In addition to publishing such information online. Physicians are also bound to provide a rough estimate of the healthcare prices to the patients upfront. Providing the costs of the care services to the patients before rendering the services will enable consumers to shop around for the best value. The availability of transparent prices on the official website or online portals of the healthcare practice will also pave the way for the in-depth comparison across metropolitan areas and states to look up which healthcare provider is providing high-quality care at affordable prices. And which may need to be named and shamed. In this way, consumers will become better able to make suboptimal decisions—like choosing the lowest-cost provider that best fits their budget.
  • In addition to this, key provisions of the transparency rule also include the public availability of the three data files. From which the first file will enlist the in-network prices for all items and services. The second file will give complete insights into all the healthcare prices for out-of-network healthcare services. Finally, the third file will contain in-network prices for all prescription drugs, as well as their historical net prices.

Implementation Of This Rule

Earlier, the CMS has initiated the crackdown to impose penalties on the healthcare facilities for failing to comply with this rule. The federal authority had announced that: a penalty of $300/day will be imposed on the hospitals having a bed capacity of 30. On the other hand, hospitals with a bed count of more than 30, will pay the penalty of $10/bed/day. But unfortunately, only 5.6 percent of hospitals managed to keep up with the price transparency rule. Approximately 80% of the 50 hospitals didn’t publish negotiated healthcare rates online.

According to the opinions of the physicians, the medical facilities failed to comply with this rule mainly due to the lack of time. Because making machine-readable files, (which is the requirement of the rule) requires a significant amount of time and effort as well. However, due to public health emergencies caused by the ongoing pandemic. Practitioners are already working with tight schedules.

They need some time to keep their billing systems compliant with this recently implemented rule. Therefore, while listening to all the concerns of the providers, The Centers for Medicare & Medicaid Services (CMS) has delayed enforcement of non-compliance penalties by six months until July 1, 2022. This extension has given hospitals more time to make every possible effort to stay compliant with the transparency rule.

Deploy a Successful Price Transparency Program

CMS’s extension in transparency rules doesn’t mean that you have to get rid of its implementation. In order to keep pace with the healthcare industry and save the practice from legal troubles. Physicians should create and deploy a successful price transparency program. Here are the useful tips that can for sure help you in achieving compliance and stay ahead of the competitors.

Get familiar with the state laws:
Different states of the United States have implemented price transparency requirements that are distinct from CMS’s requirements. Therefore, physicians should get a complete understanding of the federal as well as state laws to take further steps.

Create a task force:
Gone are the days. When healthcare providers were used to putting excessive responsibilities on the existing staff, with zero to little knowledge. Now in this modern era, the latest healthcare reforms have made the billing process extremely complicated. That requires specific skills, expertise and time as well. Therefore, practitioners should deploy highly trained administrative teams for both front desks as well as back end operations. Then conduct regular training sessions to create a sense of responsibility among them. And more importantly, to keep them updated with the ongoing evolutions in the medical industry.

Provide healthcare costs upfront:
It is one of the most talked-about topics in the United States. It is the key to keep your entire revenue cycle management compliant. It is the responsibility of the physicians to make sure that their registration staff provides a rough estimate of healthcare costs, before getting patients on board. In this way, patients will become better able to decide whether or not they can afford the care services at your facility.

Improve payer-provider relationship:
A provider’s relationship with the payers has a direct effect on the several financial policy-making processes of a hospital. Moreover, it is the requirement of the ‘Price Transparency Rule’ as well to make the negotiated rates public. Therefore, physicians should successfully collaborate with the payers to ensure the implementation of the above-discussed rule.

Streamlines medical billing process:
In order to prepare comprehensive medical bills and provide the error-free costs of medical services prior to performing certain procedures. It is crucial to having an optimized medical billing system in place. For this purpose, you must have a dedicated workforce. Hiring an in-house billing team and providing the required software/hardware can result in a quick add up in your budget. Particularly for those physicians, who are already struggling with the significant revenue loss.

In such circumstances outsourcing physician medical billing services to companies like PBC (Physician Billing Company). Off-shore billing companies provide the assistance of industry experts at affordable costs. Along with certified billers and coders. They also assign a compliance officer to make sure that your healthcare practice is fully compliant with the federal rules and regulations. They fine-tune the entire RCM process to keep your practice away from lawsuits and financial crises.

If you want to take a big leap in your healthcare practice. Then collaboration with a well-established billing service provider like Physician Billing Company will help you to drive better outcomes. We don’t let our clients lag behind the ever-evolving healthcare industry and keep their RCM systems compliant. Schedule a free demo of our transparent services and catch up with your revenue targets.


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