Lack of compliance and central repository creating laborious manual processes
The Centers for Medicare and Medicaid Services Price Transparency mandate went into effect on January 1, forcing hospitals to post their negotiated rates for services online. However, researchers are expressing frustration over the lack of compliance and the lack of a central repository for the information, causing them to manually check thousands of hospital websites.
It's "frustratingly incomplete," said Niall Brennan, president and CEO of the Health Care Cost Institute, which compiles claims data from big payers including Aetna and Kaiser Permanente.
"There is no real mechanism to figure out how many hospitals complied with the regulations," Brennan said, causing him and other researchers to "laboriously" search thousands of websites. He described it as the biggest drawback to the rule and wished the information had to be sent to CMS, as well.
Ge Bai, a researcher and associate professor at John Hopkins, agreed. "I have to say, I look at some hospitals, and the noncompliance is very common," Bai said.
Even still, it's definitely important, Brennan said, noting this information has never been available to the public before. However, in its current form, he cautions it won't be of much use to consumers.
The pricing information Brennan has seen so far largely validates what he was expecting to see: large variation in reimbursement for a single service even among commercial payers.
This is why the hospital lobby fiercely opposed the requirement, Brennan argues.
"It's just not a good look to say, 'depending on who you are and what health insurance coverage you have, the cost of the C-section can range from $5,000 to $55,000,'" Brennan said.
This information was originally published on HealthcareDive.
Are you in compliance?
Many hospitals assumed the mandate would be postponed in light of the global pandemic and already thinly stretched resources. If you’re in this boat, you’re not alone.
Quadax can help. Quickly deploy secure, compliant and user-friendly web pages where patients can interactively explore shoppable services and create personalized estimates with Payer Price Transparency by Quadax.
With Price Transparency you can:
- Ensure Compliance with new payer price transparency rules
- Rapidly Deploy organizational branding and disclaimers to your website for a seamless user experience
- Customize shoppable services and pricing required to be displayed
- Enrich the patient experience with an easy-to-use, personalized pricing calculator
- Track & Learn from patient-submitted estimate data
Need a partner to help navigate payer price transparency compliance? Let’s take on the revenue cycle together!
