Price Transparency Rules for Healthcare Industry Explained!

November 27, 2018 by admin0

The price transparency rules for the hospitals are set to change in 2019.

First, the healthcare professionals, patients, and amateur medical billing services are not clear about the implications of these new rules. Second, successful reporting of MIPS 2018 to the CMS is depending on them. Therefore, we will try to focus on getting some answers today.

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How to ensure price transparency?

That is the question!

Which format is valid?

That’s another question…

The sooner we answer these questions and others like them, the quicker we will move towards a solution. CMS answers the frequently asked questions (FAQs) to clear the fuss. The details include –

  • Hospitals that are subject to new requirements

  • The items and services in the form of a list to go public

  • Definition of machine-readability

What Does The Rule Say?

CMS finalized the rule for Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital Prospective Payment System (LTCH PPS) in August 2018. It made compulsory for healthcare providers to publicize the charges list of all the medical procedures. Another new requirement is to update the list annually and it should be in a machine-readable format by the following year.

The new rule is a blessing as it comes with many advantages.

Bridge the Gap between Clinicians and the Patients

All the advancements in the price transparency rules are to empower the patients and uplift the quality of the US healthcare industry. Price transparency means definite pricing for rendered services and medical equipment. It leads to better healthcare since anyone can see the progress through the glass. Furthermore, it is a direct step towards a constructive relationship between healthcare providers and patients.

A momentous question rises in this regard…

Can it help you score high in MIPS?

Yes, it can! It improves the chances of interoperability (health information exchange) and cost-reduction with reasonable use of resources. MIPS quality measures play a significant role in reaching a higher score against the services you offer.

The physicians get to focus on their actual work i.e. give more time to their patients. Thus, the quality of services improves and you score higher at the same time. No more stress of penalties or negative payment adjustments!

CMS’ Official Announcement about the Charges of Services

CMS clarified the final rule of IPPS/LTCH PPS for the 2015 fiscal year (FY) and made the statement public. It gives a peek into the standardized charges for hospitals, medical equipment, and services. Moreover, it is a compulsory act to publicize the list via internet in 2019.

However, hospitals have the liberty to make the list public in their desired format as long as it represents correct information.

The format with the Provision of Machine-Readability

The new amendment in IPPS/LTCH PPS for 2019 FY rule also requires the online public list to be machine-readable. By machine-readable, it means the availability of data in a format that the computers can understand. As per the CMS explanation, the format should be a digital accessible document. For example, an XML or CSV format!

PDF is a famous format but it doesn’t satisfy the healthcare price transparency requirement. Files in this format are not easy to import or read into the computer system. Thus, NO PDF format which is the restriction according to this rule.

Care Quality Information and their Respective Fee

CMS cleared away any doubts related to the implementation of these rules. It doesn’t limit hospitals to post quality information or additional charges about price transparency data. The federal government is, in fact, stepping in to fill out any gaps. It encourages hospitals to adopt the patient-friendly communication model regarding hospital charges.

It will empower patients with the freedom of choice. They can estimate potential expenses against the medical treatments. It is like price estimation for the best HD TV available on the market. When we make the prices visible on the official website, it gives room to research well before rendering services.

Finally yet importantly, it is a milestone in the healthcare industry as the patients will be able to compare charges for the same procedure in different hospitals and facilities.

The Requirements of the Federal Government

CMS, like a responsible monitoring authority, briefed about the new rule according to federal authority requirements.

CMS stands shoulder to shoulder with the federal government in the price transparency initiatives. If the hospitals or practices join hands with the state on this initiative, they are still not exempt from fulfilling the requirements of the final rule of IPPS/ LTCH PPS. Thus, the hospitals need to follow each provision by the book without any weak links.

Although these changes are for the betterment of the healthcare industry, in the JAMA Internal Medicine study, we see that only 21% of the hospitals are capable enough to provide complete information on service expenditures.

If you are underprepared or have no clues to go about it, consult the highly trained and skillful HIT consultants at P3 Healthcare Solutions to improve your financial cycles.

Shaping the Healthcare Industry!

CMS busts the bubble of unnecessary worries caused by the new price transparency law. If you have any queries that you can’t find the answer to in the article, we hope you get in touch with us directly at 909-245-8350. We will set you in the right direction. The new rule enables medical practices to plan transparent and consistent ways of healthcare solutions.


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Copyright by P3 Care Healthcare Solution 2018. All rights reserved.

Copyright by P3 Care Healthcare Solution 2018. All rights reserved.

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