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Preparing to Implement the Hospital Price Transparency Rule

Preparing to Implement the Hospital Price Transparency Rule

This category is a work in progress
Ability for health systems to prepare for implementation of the Hospital Price Transparency Rule and disclose negotiated rates, self-pay rates, and chargemaster charges.

Preparing to Implement the Hospital Price Transparency Rule: Products


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By Saeidan

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Ask Claire is the first, independent, platform that is built for people with Medicare, by people with Medicare. Ask Claire is fundamentally different from existing digital platforms in three ways: 1) It is not an online broker, so will not look to sell you 2) It is powered by CMS data and offers full access to all plan options in your area 3) It couples unbiased information about Medicare and plan choices with the power of the community so you can connect with real Medicare users to learn about their experiences
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SolutionsUser Navigation Wayfinding Solutions, Price Transparency Tools for Consumers
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Healthcare price transparency is here to stay. New federal regulations require hospitals to publicly disclose their prices and negotiated rates for care services. Non-compliance can result in steep fines. Providers outside of the hospital may also need to comply with additional state-level transparency rules. With our Shop Book and Pay™ service, providers can comply with CMS price transparency rules by creating a digital storefront to give patients the clarity they seek. By offering transparent pricing and a quality digital shopping experience, providers can drive patient acquisition, increase collections, and differentiate their business in a crowded market. Simplify Scheduling: Shop Book and Pay is as easy to use as the best online retail sites. Patients search for a specific procedure or test, comparing providers by price and quality. After choosing a provider, the patient simply adds the chosen procedure to their cart. Patients can immediately schedule the test or procedure before paying—all within the same shopping workflow. Shop Book and Pay integrates with your existing scheduling system, allowing patients to select the most convenient date and time for their procedure from your available appointments. Automated follow-up messaging confirms the scheduled appointment, which can be exported to the patient’s calendar. By automating the scheduling and payment process up front, before care is given, Shop Book and Pay helps to reduce no-shows. Patients are more likely to keep their appointments for pre-paid procedures. Comply with Transparency Regulations: As of January 1, 2021, hospitals must publish a machine-readable file of their standard pricing for all services, to include the gross price, cash price, patient’s insurance negotiated price, and the minimum and maximum negotiated price for each payer. They must also establish a consumer-friendly way to find the price for each of 70 CMS-identified and 230 hospital-identified shoppable services. Independently implementing the Shop module of Shop Book and Pay allows your hospital to comply with all of these new price transparency rules— while also distinguishing your business from the competition. Consumer-friendly shopping functionality can pave the way for a full, retail-style digital transformation. Drive Patient Volume: Hospitals and non-hospital providers can help consumers find their providers by delivering a retail-style shopping experience. Each provider can choose a closed or open configuration for its digital storefront. With a closed configuration, patients can see only the prices for a single provider, or providers associated with a hospital network. Providers may also choose to share quality and patient satisfaction ratings. With an open configuration, patients can view and compare prices for all regional providers offering a chosen service. A provider can gain valuable market differentiation by offering consumers a satisfying, quality digital experience—even if the provider is not the lowest cost provider available. Increase Pre-Payments: Shop Book and Pay helps your organization reduce the administrative costs of accounts receivable, as payment is arranged before the episode of care. From the tool’s shopping cart, patients can pay their balance in full (via credit card, health savings account, or PayPal) to receive a discount. As procedures are bundled, their cost includes every service involved in an episode of care. The patient’s purchase pays for the facility fee, physician fee, and any laboratory fees, so there’s no need to worry about additional billing. Patients who are unable to pay in full benefit from knowing exactly how much they owe. Within the tool, they can arrange financing via CareCredit. They can also choose the AutoPay option, selecting a set amount to be billed each month until their balance is paid.
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SolutionsPrice Transparency Tools for Consumers, Realtime EMR-based Cost Reporting & Transparency Tools
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By providing patients with a retail-style digital shopping experience, your organization can improve patient access, provide consumer-style pricing, and increase pre-service collections at the same time. Change Healthcare’s Care Cost SE solution helps providers move patient payments to the front of the revenue cycle, before care is delivered. Shifting to pre-service payments can reduce your cost to collect— while significantly improving your patients’ care experience. Bundle Shoppable Medical Procedures: Care Cost SE uses a unique bundling technology to make medical procedures transparent, shoppable, and instantly transactable. The platform includes all services in an episode of care, which allows for seamless, behind-the-scenes payment coordination between multiple providers. At your digital storefront, patients can view details of your available procedures and shop for care just as they shop for retail goods and services. Patients can take advantage of flexible, competitive cash-pay pricing in exchange for immediate up-front payments. As procedures are bundled, their cost includes every service and fee involved in an episode of care. The result for your patients is no surprise billing. The result for your organization is earlier, less expensive self-pay collections. Offer Cost Transparency: With Care Cost SE, providers can offer patients the consumer-style pricing they want. Patients can see the true price of care before it is delivered, and can lock in pre-service pricing. Care Cost SE offers a variety of digital payment channels, including several accepted credit cards and FSA/HSA/HRA cards. Patients can even arrange financing within the tool via Care Credit. Staff can also collect point-of-service payments at the time of appointment or scheduling. Engage Patients With Automated Outreach: Care Cost SE’s campaign management tools allow you to customize the type of communication your patients receive. Automated outreach can be triggered by a variety of events, including referral orders, scheduling events, price estimates, or preventative care notifications. Like many online retailers, Care Cost SE can also automate the delivery of shopping carts. If desired, the solution can use clinical and access-related data triggers to prompt shopping cart creation and distribution among a given patient population. Support Better Patient Outcomes: Your organization can select multiple triggering events to engage your patients throughout their healthcare journey—and encourage healthy behaviors. For example, you can choose to send diabetic patients quarterly carts populated with an A1C test visit to increase patient compliance with needed testing. By leveraging automated outreach to prompt active self-care, you can help improve patient outcomes while reducing your manual processes to collect. Newly compliant patients can also contribute to an incremental increase in volume and utilization. The solution’s omni-channel communication provides your patients with timely reminders, convenient payments, and a wealth of actionable steps throughout their healthcare experience.
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SolutionsBundled Payments Software Tools, Price Transparency Tools for Consumers
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With the growth of high-deductible health plans and the transition to value-based care, there’s a renewed emphasis on the patient financial experience. To meet patient expectations and help increase collections, you need timely, accurate information regarding eligibility, coverage, and copays. Many hospitals also offer self-service tools to engage patients who are shopping for services online as well as financial counseling at registration to facilitate upfront payments. Clearance Patient Access Suite automates the entire process. Features of our solution suite include: • Patient-facing cost-estimate tool • User-friendly dashboard • Eligibility verification and coverage discovery • Notification of admission • HIS integration • Registration data QA • Pre-authorization/medical necessity • Bill estimation • Point-of-service collections • Charity screening and enrollment The Clearance Patient Access Suite offers everything providers need to help financially clear patients and assist in collecting as early in the revenue cycle as possible. The solution helps you perform unlimited eligibility checks on every patient encounter, and assists you in getting the most complete and current eligibility information without time-consuming phone calls and manual searches. The eligibility verification capabilities of Clearance provide staff with consistent views so the most pertinent information, including key notifications, coverage dates, in/out of network views, specialized Medicare and Medicaid views, and eligibility history for an account is available at your fingertips. And by integrating with your HIS, it confirms eligibility throughout the revenue cycle for more accurate downstream billing. In addition to patient eligibility information, notification of admission details is also available. As part of an enhanced eligibility offering, Clearance Enhanced Eligibility uses advanced analytics to identify undisclosed insurance coverage. For patient accounts categorized as self-pay, its risk-suppression feature helps ensure anti-phishing compliance. Unique data sources are used to pinpoint likely funding sources in a targeted approach, presenting you with all valid commercial, government, and managed care insurance coverage. Efficiently Manage Your Workflow: The Connect Dashboard provides a base of operations to get a complete patient financial clearance profile providing at-a-glance information for action. In addition to eligibility details, patient registration data accuracy, pre-authorization, medical necessity, patient bill estimation, point-of-service collection capabilities, and more are all accessible within this same dashboard. Second, staff can utilize a browser-based floating toolbar from within the HIS to access key Clearance Patient Access Suite information without losing focus on registration system activities. Help Improve Registration Data Accuracy in Real Time: Revenue cycle success starts at registration and having accurate registration data can help result in reduced denials, fewer rejected claims, and fewer returned statements. Clearance QA helps identify errors at registration to provide accurate data for all your downstream processes, helping to enhance financial performance and keep your cash flow constant. Registration error warnings are viewable from the Connect Dashboard, helping to alert your registrars early to errors that need to be addressed. Staff can then correct the errors, helping to eliminate the need for additional FTEs to perform manual registration QA/audits. Manage Pre-Authorization and Medical Necessity Workflow: Clearance Authorization helps manage the cumbersome and time consuming pre-authorization and medical necessity processes. The solution determines if a pre-authorization is required and on file with the payer, monitors payers for pending pre-authorization decisions and updates the HIS/Practice Management system with payer results. It also provides a consistent workflow to manage both automatic and manual pre-authorization processes. Clearance Authorization also assists with the checking of medical necessity and automatic creation of necessary ABNs, helping to reduce denials, improve reimbursements, and ensure compliance with CMS. It also includes regularly updated National Coverage Decisions (NCDs) and Local Medical Review Policy (LMRP) content services to help confirm comprehensive Medicare compliance. Validate Patient Identity and Assess Propensity to Pay: Learning as much as you can about patients upfront is often a major challenge for patient access staff. Clearance Patient ID helps you verify that patient demographic data on file is correct and notifies users about patient data issues or red flag alerts that could be related to identity theft. The solution also helps you determine the guarantor’s ability and inclination to pay their bill. By screening patients and checking healthcare payment prediction scores, Clearance Propensity-to-Pay helps your staff assess the likelihood that a patient will pay, and if the payment will be timely. Offer Cost Estimates and Drive Collections: Cost transparency helps consumers make informed choices and plan for how they’ll pay for out-of-pocket expenses. It also helps providers as it enables you to engage consumers, facilitate appointments, build trust, and help increase collections. Clearance Estimator Patient Direct is a patient-facing tool housed on your website that enables patients to obtain reliable cost estimates for common procedures and services. It also helps you meet CMS price transparency requirements and includes appointment prompts to drive engagement. It is integrated with our provider-facing tool, Clearance Estimator, which uses the same charge master, contracts, and claims data to generate estimates. This solution enables you to provide cost estimates at the point of service and request payments based on the patient’s financial circumstances. Find Financial Assistance for Patients Who Can’t Pay Taking care of patients who are unable to pay is part of the mission for many hospitals. Clearance Advocate alerts users to patients who cannot pay and should be evaluated for charity, Medicaid, or other financial assistance. The solution provides an online charity screening interview and enrollment form available within the normal registration workflow. Leverage Patient-Access Analytics to Drive Change: When you want to make strategic improvements in Patient Access operations, analytics can provide the visibility and intelligence you need to make informed decisions and initiate data-driven discussions with stakeholders to drive process change. Acuity Revenue Cycle Analytics™ provides access to near real-time patient access data and trends within and across facilities, helping to provide insight into the effectiveness and financial impact of processes. Leveraging eligibility, estimation, medical necessity, and authorization data presented in an actionable format, Acuity Revenue Cycle Analytics can help you monitor, evaluate, and improve financial and operational performance.
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SolutionsInsurance Validation & Eligibility Verification, Price Transparency Tools for Consumers, Patient Intake Tools
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SolutionsPrice Transparency Tools for Consumers, Price Transparency Tools for Supplies & Purchasing
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