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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.
