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Since their introduction in January 2021, healthcare providers have largely overlooked the Centers for Medicare and Medicaid Services (CMS) price transparency regulations.
However, with CMS now imposing substantial fines for non-compliance, rural hospitals stand to gain from competitive pricing and enhanced digital engagement.
Healthcare providers are required to compile and publicly display extensive billing data, including a machine-readable file of all standard charges and a consumer-friendly list of 300 shoppable services.
Shoppable services refer to non-emergency care where prices can vary among providers. For example, a patient requiring an MRI could compare costs for this procedure at different facilities in their region based on their insurance coverage.
A recent JAMA study found that about 51% of hospitals do not comply with CMS requirements.
Healthcare providers have been slow to comply with CMS price transparency rules because it is a complex and demanding process. Facilities must gather and update a wide range of information annually for each chargeable item, including gross charges, contracted prices with each payer, a discounted cash price, and the minimum and maximum negotiated prices.
Compliance also carries financial risks, such as revealing competitive disadvantages.
The healthcare sector's recovery from the pandemic has also influenced CMS's initial hesitation to enforce the penalty of $300 per day against non-compliant hospitals.
Recently, CMS imposed significant fines on two Georgia healthcare providers, Northside Hospital Cherokee and Northside Hospital Atlanta, totaling over $1 million. This action indicates a more assertive approach to enforcement.
Going forward, CMS will audit hospital websites and review public complaints to assess compliance. Non-compliant providers will receive a warning, a request for corrective action, and potentially a civil monetary penalty, which will be publicized.
This development is an alert for larger providers lagging in compliance, but it offers an opportunity for rural hospitals to improve their market position.
Rural healthcare providers frequently offer lower prices than urban hospitals, rendering them more appealing to cost-conscious patients.
An increased customer base can significantly benefit remote hospitals struggling financially. Adopting price estimation and contract management technologies can provide accurate financial expectations for patients and ensure correct payer reimbursements.
Providing online price estimates can increase customer satisfaction. A comprehensive digital patient experience includes eStatements, online bill payment, and digital support, as well.
MEDHOST offers a solution to help hospitals display accurate, current pricing and leverage digital tools for improved patient care and revenue.
This includes a web-based search page for the 300 shoppable services, automatic generation of comprehensive, standard charges, integration with contract management tools, and minimal disruption to existing customer workflows.
For more information, reach out to us at inquiries@medhost.com or call 1.800.383.6278.
We recently had the pleasure of attending Becker's Digital Innovation + patient Experience + Marketing Virtual Event. As a partner in community hospital marketing services and solutions, we'd like to share some of the insights we were able to take away from these talks.
When healthcare consumers decide where to seek care, fundamentals remain the driving force behind their choice. They want to know if a provider takes their insurance, first and foremost. After that, price and convenience are a close second. An existing relationship with the provider is much lower on the list.
Putting this business-critical information front and center is crucial to meeting patient expectations and differentiating your healthcare facility in an increasingly crowded market.
The insights provided by an EHR can facilitate the deployment of targeted communications, which can drive business growth while reducing the costs associated with consumer engagement. This information can also help hospitals get to know their patients better through in-depth reporting.
Providers risk losing consumers in a split second when answers about pricing, hours of operation, and scheduling aren't forthcoming. These initial touchpoints are crucial to providing the level of service your facility needs to stand out.
Moreover, the relatively low cost of certain procedures at rural facilities may mean that price transparency could give community hospitals an advantage over the competition.
Price Transparency and Patient Access solutions can help hospitals put accurate and up-to-date pricing in front of new customers, leverage the latest digital tools to improve scheduling, and increase the flow of revenue. Additionally, Health Infromation Exchange (HIE) partnerships make it easier than ever for facilities to exchange vital data, benefiting both patients and providers.
Following treatment, patient-centered billing practices are the capstone of a holistic care experience. Online bill pay can speed up the revenue cycle, increase business operations transparency, and create a value-focused customer experience.
With an increasingly complex ecosystem of services offered by new startups, insurance companies, and pharmacies, the importance of consumer trust in whether patients are willing to use new technologies has come under increased scrutiny.
Among these new ways to engage with physicians, Beckers examined different competitors and how likely consumers were to engage with them using secure, online communication.
Becker’s research found that local providers are still the most trusted source of health information, even more so than an individual’s insurance company.
Now, more than ever, taking advantage of that edge is crucial for community hospitals to maintain profitability. As a suite of feature-rich mobile apps, MEDHOST Mobility offers numerous options to directly connect provider and patient.
YourCare Marketing offers an opportunity to convert this trust into revenue through digital marketing automation that helps your facility better engage with healthcare consumers. We have a variety of programs to fit your budget, and our team can augment and support your existing marketing efforts with minimal disruption to daily operations.
YourCare Marketing includes:
To learn more about MEDHOST can help your facility meet emerging trends in healthcare consumerism, reach out to us at 1.800.383.6278 or send an email to inquiries@medhost.com.
People tend to get attached to initial impressions and often find it difficult to change their minds, even when presented with incentives or evidence to the contrary.
Consequently, it's important for healthcare providers to be aware of how they come across to patients during an initial meeting and how it can impact patient service revenue.
These instances are an opportunity to deploy patient access services and solutions—reviewing and modifying any irritating parts of the front-end experience and accentuating strengths—to ensure that people leave the hospital with a favorable opinion they'll share with others.
Every part of front-end processes, from scheduling to benefits verification, can be adjusted to generate a better patient encounter, improve patient satisfaction scores, and drum up more business.
Many people think revenue cycle management (RCM) primarily occurs during hospital back-end operations, but early-stage patient engagement can make or break an organization financially. This is where patients book and register, form their first impression, and witness how others are received and treated by staff.
Training front-end personnel in appropriate data processing and giving them the proper tools to improve the patient experience is essential to creating a positive first impression at your facility.
Beyond the importance of a good experience for patients, the errors occurring on the front end of RCM can easily pop up later when collecting from insurers and patients. From the first interaction, front desk staff should think of how they can best set the hospital and patient up for billing success.
The financial portion of the patient experience begins well before discharge and includes the following:
Favorable impressions rarely start with long stretches in a waiting room.
Patient pre-registration—collecting data such as names and medical histories—can become tedious when manual, on-site processes are the only option. Software that allows for pre-enrolment helps streamline throughput, cut down on clipboard time, and ensures a better user experience.
Having patients fill out paper forms isn't just unpopular and time-consuming, it's a significant driver of denials. According to research by 3M, nearly a quarter of all claims denials are caused by registration errors.
When you consider that over half of denied claims are never revisited, this oversight adds up to a significant amount of lost revenue happening before a patient ever sees the exam room.
Many hospitals still use manual administrative and clinical functions to handle scheduling. This can include paper calendars, whiteboards, or excel spreadsheets. These methods are prone to errors, which can add up on a hospital's balance sheet over time.
For instance, when practice management software that includes alerts and automated reminders isn't part of a facility's scheduling process, it's more likely that patients will miss appointments. While this may seem like a minor issue, one study found that for each no-show or missed appointment, a hospital loses, on average, over $200.
A scheduling platform gives registrars intuitive electronic systems to use, it is easier to train current and future staff on, leadership can set standards, and software providers can receive feedback that drives continuous improvement. Ditching manual processes is also a good way to reduce healthcare worker burnout.
Eligibility and benefits verification is another critical component of revenue cycle management. When this process is standardized and efficient, revenue cycle management staff can quickly verify income, policy coverage, and benefits, helping to prevent fraud, denied claims, and protect vulnerable community members from incurring unnecessary debt.
For instance, registration staff might miss that a patient's insurance doesn't cover experimental procedures or understand that worker's compensation will be used. Without proper authorization from the insurance company, it is likely the hospital will not be reimbursed in these instances
If the most recent price transparency rules are confusing for medical business offices, imagine how confusing it can be for healthcare consumers.
Accurate price transparency can help circumnavigate many pre-payment issues. This is also another opportunity to let the patient know that prepayment is an important part of the care process, not just a transaction. MEDHOST Price Transparency helps you not only meet regulatory requirements but also helps increase patient satisfaction by helping to eradicate stress and confusion around anticipated costs.
By preventing errors on the front end of the revenue cycle, hospitals are often less likely to encounter issues on the back end.
MEDHOST works alongside providers, enabling them to promote a positive front-end experience through EHR-based software and services that allow providers to meet the technological expectations of patients and move closer to a value-based service model.
By implementing revenue cycle management leading practices and solutions, we can help add accuracy and efficiency to patient intake, billing workflows, and payments while increasing customer satisfaction.
If you would like to improve your revenue cycle today, get in touch with us at inquiries@medhost.com or call 1.800.383.6278 to learn more.
To ring in the new year, we’ve made a roundup of crucial topics to help healthcare leaders focus on what’s important in 2023: their patients and their business.
It’s been a busy year for information security.
Remote access to company servers, personal devices in the workplace, and increasing demand for mobile access from physicians have created an unprecedented challenge for traditional Healthcare IT (HIT) teams, who are now struggling to meet these evolving expectations while safeguarding valuable assets.
In this blog, we take look back on three crucial healthcare IT security topics covered by our Chief Information Security Officer, Michael Johnson, in 2022, and touch on how companies can leverage these insights and technologies to protect themselves and their sensitive data in the coming year.
More here.
The rise of the digital patient, and the consumerization of healthcare technology, has ushered in an unprecedented era of new challenges and opportunities for providers.
While the future of the digital patient experience continues to evolve, one thing remains certain: adopting consumer-centric interoperability solutions will be crucial for health systems to maintain operational and financial success in the future.
More here.
Leveraging mobile applications helps patients better manage chronic illnesses, such as diabetes, and avoid costly readmission from preventable escalations.
In this post, we’ll explore how we as a healthcare IT (HIT) partner can better empower providers to improve patient outcomes and prevent chronic illnesses from escalating out of control.
More here.
Since becoming effective in January 2021, healthcare providers have, by and large, failed to embrace the Centers for Medicare and Medicaid Services’ (CMS) price transparency rules. But now that CMS is seeking to levy hefty fines for noncompliance, rural hospitals are in a unique position to benefit from competitive prices and improved digital engagement.
More here.
We are proud of our partners who have maintained resiliency during these challenging times, and one example is Mille Lacs Health System (MLHS), a community-owned, not-for-profit healthcare organization in central Minnesota. By integrating HIT systems through a collaborative partnership with MEDHOST, MLHS has consistently provided exceptional care to the people of Mille Lacs County and the surrounding area, despite undergoing rapid change.
Watch the testimonial here.
To learn more about how MEDHOST can help your hospital prepare for the year ahead with innovative Health IT solutions, call us at 1.800.383.6278 or email inquiries@medhost.com.
Rural America is home to more than 60 million people, many of whom lack easy access to healthcare and tend to be at a higher risk for poor health outcomes than those living in more concentrated areas.
While rural providers work tirelessly to address health disparities among these underserved communities, they face an uphill battle. Outdated transportation infrastructure and labor shortages are compounded by dwindling revenue, while social factors such as rising death rates, widespread opioid misuse, and a high proportion of uninsured patients strain already overburdened resources.
This is a battle that community and critical access facilities are losing. Since January 2013, nearly 100 rural hospitals have been forced to close their doors forever.
In this blog, we’ll cover the current healthcare landscape as seen through the lens of a rural healthcare provider and touch on key strategies that hospitals can adopt, right now, to continue providing for the friends, family, and neighbors that make up the communities they serve.
New market-driven strategies supported by technological advances will be necessary for the long-term sustainability of rural hospitals.
In order to keep their doors open, these facilities must start focusing on the following strategies for continued success:
Customer relationship management (CRM), social media, online portals, and mobile applications, which are more targeted and economical than conventional advertising or community outreach, will increasingly be the driving forces behind the growth initiatives of rural providers.
Due to the higher likelihood of Medicare or Medicaid coverage for rural populations, funding for rural hospitals is dependent on meeting performance and quality benchmarks. Hospitals can better monitor and enhance patient outcomes by utilizing affordable mobile technologies and subscriptions to analytics-as-a-service.
A dependable healthcare IT partner can support institutions in expanding digital strategies to continuously engage with customers, develop a brand, and maintain compliance.
While the pandemic encouraged legislation that has helped rural hospitals bridge the patient-provider divide, such as increased flexibility related to telehealth, ongoing issues related to connectivity and recruitment put these technological innovations out of reach for many providers.
Rural hospitals should consider features and functionality specifically configured for smaller hospitals when evaluating HIT solutions. By selecting market-appropriate solutions, these providers can improve ROI and lessen the chance of cost overruns and other interruptions, which can occur when overly complicated systems are put into place without sufficient support.
Another option to lower the cost of ownership for health IT is through hosted solutions. Hospitals can host clinical and financial data through a technology partner, saving upfront hardware costs and decreasing the need for internal IT maintenance.
Interoperability, or the secure and easy exchange of electronic health information (EHI), is essential to providing value-based care, and remaining compliant, in the digital age.
While costs, staffing constraints, and on-site space restrictions may complicate deploying and maintaining EHR technology, hospitals that fail to achieve sufficient interoperability will be unable to comply with Center for Medicare and Medicaid Services (CMS) price transparency rules.
Read more about the financial benefits of achieving interoperability and the opportunity price transparency represents for rural hospitals in our recent blog.
Despite a rapidly changing healthcare landscape, rural hospitals stay rooted in their communities by adopting market-driven technological solutions.
As a proud partner of our nation’s rural health providers, MEDHOST can provide the right products, at the right price, to help these facilities provide quality patient care and maintain a healthy business.
To learn more, contact us at inquiries@medhost.com or dial 1.800.383.6278.
Since becoming effective in January 2021, healthcare providers have, by and large, failed to embrace the Centers for Medicare and Medicaid Services’ (CMS) price transparency rules. But now that CMS is seeking to levy hefty fines for noncompliance, rural hospitals are in a unique position to benefit from competitive prices and improved digital engagement.
To be in good standing, providers must compile vast amounts of billing data and post this information online, including a machine-readable file of all standard charges and a consumer-friendly list of 300 shoppable items and services.
Shoppable services include non-emergency care that may vary in price depending on the provider. If a patient needs an MRI, for instance, and they have four facilities in their area, they would be able to visit each facility’s website and see the cost for that procedure based on their insurance payer.
According to the most recent JAMA analysis, however, approximately 51 percent of hospitals do not adhere to these specifications.
Complying with these rules isn’t as easy as it sounds.
To begin, hospitals must cull and maintain a great deal of information. For each chargeable item, compliant facilities are required to list gross charges, each payor’s contracted price, a discounted cash price, and a de-identified minimum and maximum negotiated price, while ensuring these numbers are updated annually.
Next, compliance can represent a serious financial liability for providers. Potential consequences of up-front pricing include jeopardizing payer contracts, exposing competitive weakness in a tight market, and demanding intensive admin work from already understaffed back offices.
Finally, with the healthcare industry still excavating itself from the effects of the pandemic, CMS was reluctant to enforce the proposed penalty of $300 a day against hospitals that ignore or fail to satisfy requests for corrective action.
CMS sent shockwaves through the healthcare industry earlier this month when it levied fines for the first time against two Georgia hospitals: Northside Hospital Cherokee and Northside Hospital Atlanta. With a combined price tag of over $1 million, these penalties sent a clear message that the government will take an aggressive stance on enforcement moving forward.
Accordingly, CMS will audit hospital websites and evaluate complaints made by individuals to determine whether these facilities are in good standing. For providers that do not comply, they will issue a warning notice, request corrective action, then impose a civil monetary penalty and publicize the infraction on their website.
While this may come as an unwelcome wake-up call for big providers who have been dragging their feet on compliance, the scramble to meet federal policies represents a rare opportunity for rural hospitals to cash in on improved positioning.
Facilities in unconcentrated healthcare markets often have lower prices than their urban counterparts.
Getting these competitive prices out front, especially during a tough economy, may make otherwise overlooked healthcare destinations more attractive to those seeking treatment.
A trusted partner in healthcare IT can help facilities continuously engage with consumers, build their brand, and increase revenue through an expanded digital strategy.
The revenue that comes with an expanded customer base can present a welcome respite for remote facilities that have been struggling for years to operate in the black.
Adopting technology-driven price estimation and contract management services and solutions can not only help smaller practices by providing patients with more accurate financial expectations up front, it can also ensure that facilities are reimbursed correctly from payers after care is complete.
Empowering patients with online price expectations improves customer satisfaction. But furnishing accurate price estimates on a hospital’s website, and at registration, is only part of the opportunity for engagement.
By implementing a comprehensive digital patient experience, hospitals can provide anywhere-access eStatements, online bill pay, telehealth options, and the flexibility of digital support that modern consumers expect.
The MEDHOST Price Transparency Solution can help hospitals put accurate and up-to-date pricing in front of new customers, leverage the latest digital tools to improve patient care, and increase the flow of revenue. Our offerings include:
It’s time rural hospitals had the edge. We’re here to help. To learn more, contact us at inquiries@medhost.com or call 1.800.383.6278.
Although the mandate has been established for over a year, the Price Transparency Rule continues to evolve.
As the rule transitions, along with updates from our team, we are making it a priority to share what we learn to so none of our customers are caught off-guard.
On November 27th, 2019 CMS released the OPPS (Outpatient Perspective Payment System) final rule, which contained requirements for hospitals to make standard charges public. Under this rule, hospitals are required to make publicly available, online, a machine-readable file of all standard charges for all items and services and a consumer-friendly list of 300 shoppable items. Price listings must contain certain information for each item or service provided by the hospital, including:
These requirements had an effective date of Jan 1st, 2021. This past April, CMS began sending out warning letters stating the hospital had a specific timeframe in which to correct the identified non-conformance. Civil monetary penalties of $300 a day could be levied against hospitals that ignore or fail to satisfy the CMS request for corrective action.
In March of 2021, Health Affairs analysis had cited that 65 out of 100 of the nations largest hospitals were non-compliant with the transparency rule. A second study conducted by Milliman found that 32% of the included health system did not post the required files, and those that did had a wide variance in the content and presentation.
CMS is not taking the industries inattentiveness to the transparency rule lightly. On July 19, CMS made the OPPS 2022 proposed rule available for public viewing. In the rule CMS is proposing to significantly raise the monetary penalties for hospitals that have more than 30 available beds, as reported on the most recently finalized Medicare cost report.
In brief, for hospitals that have a 30 or fewer bed count, the penalty will remain the same. For larger hospitals, CMS is proposing to penalize non-conformance with the transparency at a rate of $10 per bed per day for a maximum of $5,500 a day per hospital, or $2,007, 500 per year.
Our hospital partners who have adopted the MEDHOST Price Transparency solution can be confident they are in compliance with the regulations and meet all requirements. Our solution has been designed and implemented in accordance with CMS’s Final Rule (CMS-1717-F2) and guidance provided on the CMS Hospital Price Transparency website.
If your hospital or healthcare organization is still working towards Price Transparency Rule compliance, now is the time to make the mandate a priority. For further details on how we can help you meet the Price Transparency Rule requirements, contact your MEDHOST Account Executive or please reach out to us at inquiries@medhost.com or call 1.800.383.6278.
Act now to avoid non-compliance and potential fines.
The Centers for Medicare and Medicaid Services’ (CMS) Price Transparency Rule, which became effective January 2021, requires licensed hospitals to make public a list of standard charges in a machine-readable format along with a second list of “300 shoppable items.” CMS has now begun auditing hospitals’ websites and price transparency compliance submissions. Following the audits, CMS has also begun to send warning letters, moving forward with Price Transparency enforcement.
In March of 2021, HealthAffairs.org conducted an analysis of the top 100 United States hospitals for compliance to the new rule. HealthAffairs.org found 60 percent of the hospitals surveyed were non-compliant with the rule’s basic requirements.
Compliance with the rule is not as straight forward as it may sound. For each chargeable item, hospitals must list gross charges, each payor’s contracted price, a discounted cash price, and a de-identified minimum and maximum negotiated price. This list must also be actively maintained.
Hospitals that receive warnings are given a 90-day window to address shortcomings. Depending on the hospital’s response, CMS may close its inquiry, deliver a second warning letter, or request a corrective action plan from the hospital. Civil Monetary Penalties of up to $300 a day could be imposed for non-compliance.
If you have adopted the MEDHOST Price Transparency solution, you can be confident that our solution complies with the regulations and meets all requirements. Our solution has been designed and implemented in accordance with CMS’s Final Rule (CMS-1717-F2) and guidance provided on the CMS Hospital Price Transparency website.
However, if your hospital or healthcare organization is still working towards compliance, now is the time to make price transparency a priority. For further details on how we can help you meet the Price Transparency Rule requirements, contact your MEDHOST Account Executive or please reach out to us at inquiries@medhost.com or call 1.800.383.6278.
The Price Transparency mandate from The Centers of Medicare & Medicaid Services (CMS) was designed to provide patients with the ability to manage their healthcare through published prices for services and procedures.
This mandate creates opportunities for hospitals to create better patient experiences with enhanced financial clarity, but non-compliance risks fines and reputational consequences for hospitals beginning January 1, 2021. Greater risks may result from litigation or lost revenues from perpetuating poor billing practices.
The initial version of CMS’s price transparency rule was effective in January 2019. It required that hospitals publish standard list prices in a machine-readable format online. Enhancements to this initial rule were finalized in November 2019. The final rule requires hospitals to provide a consumer-friendly and searchable display of 300 shoppable services including gross and discounted cash prices, payer specific charges, and de-identified minimum and maximum charges on a publicly accessible website. This information must also be included in a machine-readable file. Legal challenges to the ruling and requests for delays due COVID-19 failed and the rule went into effect on January 1, 2021 as planned.1
This final rule comes with strict monetary penalties. Hospitals that do not meet the requirements under this rule may be subjected to a $300 per day fine, as well as the potential to lose Medicare payments altogether. Since mid-January, CMS has also publicly identified noncompliant hospitals by naming them on the CMS website. This disclosure not only affects a hospital’s reputation but creates a tort bar practice development tool.
CMS has announced that it has started auditing a sample of hospitals to ensure compliance with the rule and is asking the public to report noncompliance through a form on their website. Patients are encouraged to notify CMS if they can’t find a hospital’s standard charges online.
A noncompliant hospital may be asked to provide CMS with a corrective action plan. If the corrective action plan is not provided in a timely manner, then CMS will initiate monetary penalties and public shaming. Currently, CMS is not allowing hardship waivers or exemptions.
The Price Transparency solution from MEDHOST enables providers to comply with Price Transparency Policy. Learn more about how we can help you become compliant by contacting us at inquiries@medhost.com or calling 1.800.383.6278.
1 https://www.cms.gov/hospital-price-transparency
The Price Transparency Rule goes into full effect January 1, 2021 for hospitals. To be compliant and avoid the $300 per day penalties, preparation needs to begin now. MEDHOST is committed to helping our Community Hospital customers to meet this regulatory challenge.
In an article posted at the beginning of 2020, we offer a quick breakdown of four core Price Transparency facts. According to the rule, hospitals will be required to provide the ability to search a minimum of 300 shoppable services in a public place.
To ease the transition to compliance, MEDHOST built first generation Price Transparency tools and services into our current digital patient management solutions. Ultimately, our system will update shoppable services in real time as payor contracts and charge masters are updated. Current payor contracts and charge masters avoid patient dissatisfaction resulting from presentation of inaccurate information as well as preventing revenue loss. Many competing price transparency solutions magnify this problem by presenting past billing errors.
The MEDHOST Price Transparency solution simplifies the creation of shoppable features for facility procedures and services on a public-facing hospital website. In addition, the MEDHOST solution will:
The importance of staying current with mandates could trickle down to negatively impact patients and providers. While getting regulations right the first time is critical for hospitals and clinics, unfortunately, many healthcare facilities lack the time and staff to achieve these demands. However, they don’t have to manage these new Price Transparency challenges alone and settle for less than the best. MEDHOST has strategically provided a way for facilities to help solve for Price Transparency regulatory challenges. It is also an opportunity to improve revenues through better maintenance.
MEDHOST revenue cycle management specialists have noted two major challenges that may arise from Price Transparency requirements:
Partnering MEDHOST’s Price Transparency solution with MEDHOST’s Contract Management Solution and Contract Management Services can help facilities solve the challenges above, so they don’t have to spend time digging through the weeds on their own. Our Contract Management Solution works within the MEDHOST system, without requiring additional connectivity or data extractions to third-party systems, to produce accurate and up-to-date price estimates by ensuring insurance payor contracts are updated regularly. Additionally, our team identifies accounts to recover insurance underpayment reimbursements for facilities.
Through ongoing regulatory changes, we maintain a commitment to deliver timely, cost-effective solutions, to help hospitals save time resources, reduce cost, maximize revenue, and create better experiences for the communities they serve.
Start preparing today. We’re here to help. To learn more contact us at inquiries@medhost.com or call 1.800.383.6278.
