On Nov. 15, 2019, the Centers for Medicare & Medicaid Services (CMS) finalized policies that will make prices for items and services provided by all U.S. hospitals more transparent for patients so that they can be more informed about what they might pay for hospital items and services. The compliance date for these new rules, which lay the foundation for a patient-driven healthcare system, is Jan. 1, 2021.
There are two components to compliance with the new rules:
Comprehensive machine-readable file
A single machine-readable file will be made available, one that contains all five types of standard charges for all the items and services provided by the hospital, which include: 1) the gross charge (charge found on a hospital’s charge master, absent of any discounts), 2) the discounted cash price for any uninsured consumers, 3) the payer-specific negotiated charges (negotiated rates for all payers, including commercial, Medicare Advantage, and Medicaid MCOs), 4) the de-identified minimum negotiated charge, and 5) the de-identified maximum negotiated charge.
- The WVU Medicine Payer Relations Department is working diligently on preparing compliant machine-readable files for all system hospitals that will be available by the Jan. 1, 2021, compliance date. Each WVU Medicine hospital will have its own unique comprehensive machine-readable file that will be publicly accessible on the WVU Medicine website under the following path: Patients & Visitors → Financial Assistance → Current Standard Charges
Consumer-friendly shoppable services
Hospitals must make public standard charges for at least 300 “shoppable services” (including 70 CMS-specified and 230 hospital-selected) the hospital provides in a consumer-friendly manner.
- Compliance with the shoppable services requirement will be achieved through Epic’s estimator tool, available to patients through the MyWVUChart portal. This self-service tool will provide an estimate to patients for a specified set of procedures utilizing three components: 1) the estimated gross charges for the specified procedure, 2) the payer’s allowable charges or estimated payment amount per the contract (if applicable), and 3) the patient’s insurance benefits, applying copays, deductibles, coinsurance, and out-of-pocket max amounts to the estimate to produce an estimate of the patient’s out-of-pocket responsibility for the service. By Jan. 1, 2021, WVU Medicine will have more than 300 procedures available for self-service estimates for all facilities throughout the system. The patient will be able to access the tool via the portal either with or without a MyWVUChart account.
These procedures will be released to the public in three phases; click here for a chart to see the schedule for services to be added.
The phase-in process will allow WVU Medicine to test the tool and obtain feedback to continue to enhance the tool as the enterprise expands the number of procedures that are available.
For questions about the MyWVUChart self-service estimator tool, please contact Jeanette Stevens, enterprise manager of financial counseling, at firstname.lastname@example.org.
For questions about the comprehensive machine-readable files, please contact Mark Cassis, contracting specialist, at email@example.com.
For more information about the price transparency requirement, please visit the CMS website: https://www.cms.gov/hospital-price-transparency.