Hospital Price Transparency Implications: Fallout from the CMS Final Rule Effective in 2021
Stephanie Kanwit, Of Counsel, will present "Hospital Price Transparency Implications: Fallout from the CMS Final Rule Effective in 2021," a webinar hosted by HealthcareWebSummit.
The Centers for Medicare & Medicaid Services (“CMS”) recently issued a final rule requiring hospitals to publicly disclose their rates, including negotiated rates with third-party payors regardless of product line, by January 1, 2021. The Final Rule’s intent is to increase price transparency so that health care consumers can “shop” for health care services. The Final Rule does not exclude any particular type of health plan, product, or line of business, except for rates that are not negotiated (e.g., fee-for-service Medicare or Medicaid). Hospitals that are deemed non-compliant are subject to fines of up to $300 per day, up to a maximum of $109,500 per year.
Despite issuance of Final rule on price transparency, the question remains if health care rates are too complicated to be “consumer friendly.” There are many hurdles that hospitals must overcome to meaningfully comply with the Final Rule, and it is questionable if they will even be able to provide useful data to consumers. And even if they are able to, it is questionable whether consumers will be able to make effective use of the data.
In addition to covering the provisions and scope of the Final Rule, and how the Final Rule would impact both hospitals and consumers when making health care decisions, this session will demonstrate by means of illustrative example how a potential patient could make use of the data required by the Final Rule and the limitations hospitals will have in providing reliable information.
In this session, Ms. Kanwit examines the provisions, complexities, challenges, implications and outcomes of the CMS Hospital Price Transparency Final Rule.
- The provisions set forth in the CMS Hospital Transparency Final Rule
- The complexities surrounding the scope of the Final Rule
- The challenge of making a hospital’s negotiated rates “consumer friendly”
- Illustrative examples in the application of risk adjustment
- Practical implications and outcomes for hospitals, consumers, and regulators
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