The North Carolina Healthcare Association and North Carolina Chapter of the Healthcare Financial Management Association virtually hosted the 2022 Annual Government Payors Summit. PYA Director of Business Intelligence & Analytics Jason Hardin and Senior Manager Kathy Reep presented during one of three sessions addressing the latest legislative and proposed regulatory changes in healthcare, including both the Inpatient and Outpatient Prospective Payment Systems final rules and price transparency. The event also provided a forum for discussing reimbursement and audit issues.
As of January 2021, hospitals are required to comply with price transparency requirements issued by the Centers for Medicare & Medicaid Services (CMS). These requirements include posting a machine-readable file containing payer-specific negotiated rates and a second file with at least 300 shoppable services. In addition, hospitals and healthcare practitioners are now required to provide Good Faith Estimates (GFEs) beforehand for services scheduled at least three business days in advance and for those inquiring as to price even when not scheduling a service. Jason and Kathy’s session, “Price Transparency—Using the Data,” addressed both price transparency and GFEs, including:
- A review of the CMS requirements related to the posting of rates.
- Insight into identified errors in the current data.
- Insight into hospitals’ negotiated charges for their contracted payers.
- Examination of the variation in pricing for similar healthcare services.
- Use of the posted data in benchmarking negotiated rates.
- A look at PYA’s new “Negotiated Pricing Dashboard” to share the utility by hospitals.
The summit took place September 21, 2022. View the presentation slides here.
If you would like assistance with price transparency issues, or any matter involving compliance, valuation, or strategy and transactions, one of our executive contacts would be happy to assist. You may email them below, or call (800) 270-9629.
