Solutions to Price Transparency Compliance

With the new CMS fines for hospitals in non-compliance with the Price Transparency rule, administrators may feel like they need to play catch up to avoid being targeted by CMS. The tasks of trying to convert thousands of individual charges and hundreds of contractual variations to price transparency shoppable services and machine-readable file can be overwhelming. But based on our years of experience in charge capture, coding and price transparency compliance work, we highlighted five steps all hospitals can take to start their journey on the road to compliance using our standardized price machine-readable template:

1.     Primary Service Codes: hospitals can begin by organizing their services based on primary service codes. A few examples would be individual HCPCS codes, non-HCPCS coded services (e.g., R&B), and multiple charges grouped by Primary service identifier (e.g., DRGs. ASCs).

2.     Payer Plans: the next step is to organize payer plans based on contractual terms and populate charges per price transparency rule for each primary service and each payer plan.

3.     Self-pay Discount Rates: each item and service should be matched to their self-pay discount rates.

4.     Min and Max Charges: identify the low and high charges for each primary service code.

5.     Compile: hospitals should populate the organized data from steps 1 through 4 into a file that can be easily accessed by patients and maintained internally.

Hospitals should also organize a core team to maintain the price transparency machine readable file and 300 shoppable services with a proper audit trail and guiding principles.

Following this roadmap allowed us to improve our price transparency compliance turnaround time for clients from approximately 4 months in 2020 to 2 months in 2021.