CMS Healthcare Price-Transparency Regulation Explained
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- čas přidán 10. 07. 2024
- The CMS Healthcare Price-Transparency Regulation Went into Effect on Jan. 1, 2021.
The Price-Transparency Regulation Requires Hospitals to Post 1) Billed Charges, 2) Maximum and Minimum Negotiated Rates (Prices) with Insurance Carriers, 3) the Cash Price for a Patient that Does Not Have Insurance and 4) the Payor-Specific Negotiated Rates (e.g. for Blue Cross, United Healthcare, Cigna, Aetna, etc.)
Hospitals Will Be Fined $300 Per Day if they Do Not Comply and They Will Be Listed on a CMS Website of Non-Compliant Hospitals.
Hospitals Must Post Prices for 300 Services, 70 of Which Are Dictated by CMS.
An Example Hospital's Price-Transparency Data File is Reviewed... the Findings are Quite Surprising!
Sources: www.cms.gov/hospital-price-tr... • Hospital Price Transpa... ; www.federalregister.gov/docum... baptisthealth.net/locations/h... www.floridablue.com/sites/flo...
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#HealthcareCosts #PriceTransparency #HealthInsurance
I definitely appreciate your videos. Thank you for taking the time to create them.
Thank YOU for watching and for your kind comment.
Great video, as always. I'm in disbelief regarding lack of reporting with Baptist/BCBS/UHC, and $300/day hardly a "stick". Great point about hospital ability to randomly post 270 additional lab costs as an easy way to get compliant. Smh.
Thank you for watching and for your comment!
Dr. Bricker: You are asking a Hospital to post what an insurance BX or UHC would pay on a particular CPT code. As a Revenue Cycle expert, I don't see how they can do it. The reason you have N/A for BX & UHC is because the price UHC & BX pays for a specific CPT codes varies. A hospital could audit a thousand claims for a specific CPT code paid by BX, and come up with a different payment each time. I can talk privately with you on why this is if you wish. When you talk about 'Price Transparency' from hospitals, you should include 'Payment Transparency' for insurance companies as well. Regarding accepted 'Cash Payments'. I understand hospitals are supposed to do this, but here is the problem they will encounter. Insurance carriers will only pay the cash price. Their argument is, 'if the cash price is X, then that is the price of the service'. This has already been through the court systems in favor of the insurance carriers.
Hi Ken, Thank you for watching and for your comment.
Are hospitals are the only entities require to disclose costs? What about private practices or clinics? Very interested to know how the CMS regulation can help people frankly not be ripped off by the business people in healthcare services. We live in a country where healthcare costs are out of control. Thank you!
Great question… only Hospitals. Other healthcare facilities would be helpful too, to your point.
Thank you for watching.
Great overview. Very helpful
Thank you for watching and for the compliment.
@@ahealthcarez Curious of your opinion on what this will do to pricing over time from the consumer standpoint. Do you think these changes will have the desired effect and we see costs go down, or the opposite occur and price stickiness will ensure and prices will hold or even increase as no hospital wants to be reimbursed less than a fellow facility
From what I've experienced in SE Wisconsin, Average Billable Allowance, not Medicare RBP+%, is the new Provider Contracting Price Tool in the 2020s between Mega Self-insured Groups with their BUCA Claims Payer and Healthcare Providers; especially when On-site clinics are involved. The PPO Plan obtains the Average Allowance from their BUCA, per CPT, and pays at the 60 or 70th Percentile, lists that Blues allowance on the employees' Smartphone or Android, and Patient Chooses ( a.k.a.Consumerism) to go to that In-Network Provider or go OON and pay the Balance Due.
My guess is The Blues Average Allowable can be upheld as "Work Product" and RBP% cannot. Also, for 2020s PPO Employer-driven Healthcare Provider Contract Agreements, Hospital Systems & ASCs will not want them tied to Medicare RBP Allowance. Final Opinion; Average Billable Allowed Pricing, easily moves to Bundled (CPT) Billing & Payment, for the 13 Orthopedic Surgical Procedures performed at the local ASC, as created by the Employer & the ASC, based on Shared Data.
Thanks!
Thank you for sharing your knowledge, Andrew!!
It’s about time.
Thank you for watching and for the comment.
Dude, I did not understand, I really wanted too.
Thank you for watching and for your feedback.
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