Why Basic Compliance with CMS IPPS Isn’t Enough

Nov 7, 2019 | Blog Article

We’ve got something to get off our chests: posting a chargemaster doesn’t automatically equal price transparency. Let us explain. 

Presenting prices for hundreds of billable services and products — everything from the price for a bed per day, blood tests and surgical operating room time, to the cost of a single Tylenol tablet — isn’t helpful for healthcare consumers. In fact, it’s confusing, time-consuming and may result in delayed or avoided care. 

You can’t list services in obscure abbreviations, billing codes, and medical terminology and expect patients to find it helpful, or even bother to look at it, for that matter. In most cases, these posted rates are the highest dollar amount a hospital would ever charge per service, not a true patient estimate. 

Okay, maybe we’re being a bit dramatic. You have a good start, a good foundation. You’re following the rules. But what we’re trying to say is, it’s not enough.

Sure, the CMS said full public disclosure was a logical first step in a transparency initiative aimed at one day encompassing physician and prescription drug prices, but if anyone thinks a chargemaster is a good tool consumers will use to comparison shop, you’re sorely mistaken.

Rather than empowering shopping around or providing true patient estimates, these obscure lists force consumers to think one thing and one thing only: “What the health?” 

Stop Settling for “Just Okay”

If you take anything away from this article, take this: you can do better. And you should want to. Why? 

The average deductible for a worker with employer-provided health insurance was $303 in 2006. Fast forward 11 years. That amount inflated by nearly 400% to $1,505. Let that sink in. 

People are now paying 5 times as much as they were in 2006. If the trend continues, how much more will they be paying by 2020? 2030? Talk about stressful.

Yet many people still remain uneducated with regard to their healthcare, co-pays, and deductibles. Meaning that instead of attempting to get the best bang for their buck, many people do the opposite, resorting to only once-a-year visits, I’m-everything-but-dying visits, or no visits at all. And that’s a problem. A big one. 

In order to inspire loyalty, build lasting relationships, and collect those patient payments, you must create a consumerism strategy that delivers true price transparency. (Read: not a list of unrealistic prices.) We’re talking an accurate, real-time patient estimate. 

Building a Consumer-Focused Price Calculator

Price transparency is practically the buzz-phrase of the year. As such, many vendors are hopping on the patient estimation train. But, as we’re sure you know, not all vendors are created equal. That’s why we’ve comprised a list of features you should look for when selecting your patient estimate solution.

1. Benefits Verification. Real-time benefits should be obtained via EDI and payer websites to ensure the most complete information available (including out-of-pocket maximums and remaining deductible amounts).

Staff can then use the patient’s current coverage to apply the most appropriate benefits to the selected procedure, allowing for an accurate, up-to-date estimate tailored specifically to said patient. (Notice how we used the word “specific”.)

2. Coordinated Calculations. Patient responsibility should be calculated based on your organization’s facility charges for the services provided, your payer contract rates, and the patient’s insurance benefit information. Healthcare isn’t one-size-fits-all. Your patient estimates shouldn’t be either.

3. Self-Service Estimates. Everything and everyone is online nowadays. We’re not trying to sound old. We’re just stating the facts. As such, why wouldn’t you want to offer a way for patients to calculate their own estimates (on their own time) online?

You need a vendor that delivers a patient-driven online price transparency product with a real-time estimated cost of healthcare services, along with a patient’s estimated out-of-pocket expenses. Moreover, that summary should include their copay, deductible, coinsurance, and any other costs not covered by their insurance. 

The Wrap Up

Having access to the right data is one of the central themes of consumerism. While it is true that more data is available now than in previous years, much of it is hard for the average patient to understand and use.

This gives your organization the unique opportunity to partner directly with your patients to proactively steer them to helpful information. Transparency is key. But only the real kind, not the kind found buried deep in your chargemaster. 

It is difficult for consumers to make informed decisions about the value of their healthcare plans without access to reliable data. For patients with high deductibles and large out-of-pocket costs, that data is even more crucial. By coming forward about prices and providing an accurate patient estimate, your organization stands above the competition. 

Still not sold? With clear information about how much they will actually owe before their visit, your patients are even more likely to actually pay you. In full. 

Yeah. We thought you might like that.

See how you can provide a real-time accurate patient estimate based on current levels of coverage right on your website or patient portal with MySurePayHealth by Recondo.

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