How Hospital Price Transparency Mandates are Affecting Healthcare

Breaking Down How Hospital Price Transparency Works and Its Benefits

At multiple points in our lives, the need for medical services is going to arise. Everyday people get sick, get injured, or require a vaccine to prevent a new form of illness from affecting them such as COVID-19. Healthcare is a regular ongoing process in this country. For those who are lucky, you may go years at a time without requiring a doctor’s visit beyond your regular check-up. For others, you may require an immediate surgery or procedure done due to a stroke, car accident, or other critical event that lands you in the hospital. Regardless of what the medical ailment is, what most people can agree upon is that the cost of healthcare is typically a surprise when it comes to patient billing. In fact, recent statistics show that roughly one out of every five Americans deal with medical billing companies because they are carrying some form of debt with a healthcare provider.

Unlike shopping for a car or a house, the price of a major or minor medical procedure usually isn’t apparent to those getting it until it’s too late, which means the medical billing company is usually the one to break the news to the patient. That brings us to the topic of hospital price transparency.

What Is Hospital Price Transparency?

Hospital price transparency helps Americans see the prices of medical procedures, services, and medications before they are actually billed. Dating back to January 1, 2021, all hospitals operating in the United States are required to provide clear and accessible pricing information online about the items and services they provide. This pricing information is provided in two ways.

1. A comprehensive machine-readable file with all items and services provided by the hospital or healthcare provider. The file will contain the following standard charges for all items and services provided including gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.
2. A display of shoppable services in an easily readable format. The display will include at least 300 “shoppable services” or as many as the hospital provides if less than 300. “Shoppable services” is defined as services that a healthcare consumer can shop for in advance. The descriptions must be provided in plain language, and they must be grouped with ancillary services. The following will be provided for the shoppable services: discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

The intent is to make medical billing companies be more transparent so that the patient billing process is more manageable for healthcare consumers.

What Are the Advantages of Hospital Price Transparency?

Hospital price transparency makes it easy for healthcare consumers to shop and compare prices across hospitals and healthcare providers, therefore, allowing them to make more informed decisions about their healthcare. In the event that you need x-rays, imaging, lab tests, or other bundled medical services, you will be able to see the prices of all those services beforehand. You will also be able to price compare those services amongst the hospitals and healthcare providers in your area, which will allow you to identify the one with the lowest price. This not only empowers the healthcare consumer, but it also puts pressure on healthcare providers to be more competitive in their pricing because they too can compare.

What Are the Challenges of Hospital Price Transparency?

When it was originally decreed that hospital price transparency would need to be universally rolled out by January 1st, many healthcare providers complained that that was simply not enough time to implement this new system. Most of them cited a lack of IT resources to get all the pricing information ready, formatted, and tested before rolling it out for the public. For other healthcare providers, some were simply unwilling to implement hospital price transparency, which is resulting in a $300 per day penalty for not complying with the new rule.

However, the good news is that many hospitals and healthcare providers are already complying. In the event that your current healthcare provider isn’t complying with hospital price transparency yet, chances are that there are several other healthcare providers in your area that are. If you know of a hospital or healthcare provider that isn’t providing pricing information, you may file a formal complaint against them at cms.gov on their contact page.

What is the Role of an Extended Business Office as it Relates to Hospital Price Transparency?

As previously detailed, hospital price transparency helps patients better understand their medical billing before it’s processed. This gives healthcare consumers a better idea of what to expect and allows them to set aside the required funds they’ll need for healthcare services. Hospital price transparency is still a relatively new concept, which means there are plenty of Americans that are still getting bills that need to be explained in a way that is easy to comprehend. This is the principal advantage of working with an extended business office (EBO). These are customer service-oriented companies that work on behalf of hospitals and healthcare providers as it relates to medical billing services.

Medical billing specialists that work at extended business offices will take the time to explain charges that are appearing on bills so that healthcare consumers understand them. Early-out services allow medical billing specialists working with an EBO to contact the patient in the earliest stages of delinquency. This sort of enhanced communication regarding patient billing increases the likelihood that a patient will pay their bills, and therefore, increases the overall revenue cycle for the healthcare provider.

Let Assistentcy Handle Your Patient Accounts

The team of professionals at Assistentcy has all the experience and resources needed to help patients navigate the world of medical billing. Our friendly customer service reps treat your patients with the same care and respect as you would in your healthcare facility. Patient education, convenience, and customer service are our priorities.

Data shows that our flexible early-out programs have improved hospital revenue cycles and increase debt recovery. Find out how by contacting Assistentcy today!