CostFlex Price Transparency Tool
INTRODUCTION TO TRANSPARENCY
Transparency of Pricing, also called “Hospital Price Transparency” (see: https://www.cms.gov/hospital-price-transparency), is a law that requires hospitals to post their standard charges as well as the negotiated rates by insurance carrier for 300 “shoppable” services that a healthcare consumer (patient) can schedule in advance. If non-compliant, hospitals could face a fine of $300 per day and the withholding of Medicare payments if they are not in compliance by January 1, 2021.
THE COSTFLEX TRANSPARENCY SOLUTION
To provide a true solution, a hospital will need the ability to group their historical patient population into services (shoppable services), automate all of the detailed payer contracts associated, calculate the reimbursement for all services using a representative patient sample through the fully automated contract terms, and finally post the resulting data to a public website for the consumers to view and use for personal comparisons.
For any and all CostFlex clients that have both the Patient/Service Line Cost Accounting module and the Payer Contracts Analyzer module, they already have the ability to process and report the Pricing Transparency now!
To assist our clients with this task and required reporting, CostFlex has been working directly with existing clients for the last several months to perfect the classification of “Shoppable Services” by payer (a requirement) and to ‘marry’ these with their automated payer contracts in CostFlex.
The solution that CostFlex clients are using consists of a three-step process that involves existing tools:
- Using the Product classification utility (CostFlex specific tool), clients can classify patients into one of the 300 shoppable services.
- Using the Payer Contracts Analyzer module, each of these classified patients can then be calculated against 100% of all the client’s modeled contracts to calculate the “Allowed Amount,” or what each insurance contract would reimburse.
- Using the provided standard exports, a statistically significant collection of patients can then be grouped by Shoppable Service with the Allowed Amount for each contract displayed and exported for use by the hospital team for publishing.
PRESENTATION LAYER (REQUIRED)
As about 50% of the hospitals in the United States are relatively small (i.e., fewer than 100 patient beds) and do not have a large IT staff, CostFlex has created a custom presentation layer to help them (or any other organization that needs a presentation layer for Transparency).
This means that CostFlex clients can perform the three steps mentioned above and then click a user interface button to extract the process data to be sent to CostFlex for publishing. CostFlex will then update a database with a link to a website that the end user (i.e., hospital) can place on their own website with a forward-facing form for patients to access and see their rates.
CostFlex Support staff are standing by to answer questions, provide a Web demonstration, and/or assist our clients with any or all parts of the described.
Below are some useful links: