Revenue Masters ensures hospital providers meet final CMS rule requirements by utilizing it’s contract modeling engine. Full compliance is not possible without contract modeling.
Beware - many pricing transparency products are not in compliance
CMS Mandate - Possible Fines! - Must Use Contract Modeling
On January 1, 2021 the CMS mandated hospitals provide their services pricing transparency via a "Patient Facing Website" or face a $300 daily fine per facility.
It's proposed to INCREASED! A full year of non-compliance could soon range from $109,500 to $2,007,500 per hospital.
BEWARE MANY VENDORS ARE NOT IN COMPLIANCE CONTRACT MODELING IS REQUIRED
Per the CMS guidelines of August, 2021 pricing cannot be created from aggregate or average charges
Revenue Masters web-based solution, Payer Glass, combines machine-readable file compliance with a patient-facing tool that meets the requirements to display shoppable services in a consumer-friendly manner. Payer Glass’s CDM solution displays gross charge third-party negotiated rates, de-identified minimum negotiated charge, de-identified maximum negotiated charge, and discounted cash price.
Hospital Pricing Transparency
Meet the 2021 CMS Pricing transparency final rule requirements and avoid possible daily fines.
Meet the CMS Final Rule
- Machine-readable file with charges, third-party negotiated rates, deidentified minimum charge, deidentified maximum charge, and self pay discount rates (including CDM)
- 300 (70 CMS- specified and 230 hospital selected) customer friendly Shoppable services
- Cost reporting mandate to report Medicare Advantage (MA) plans median payer specific negotiated rates
Model all third-party payer inpatient and outpatient rates to obtain the CDM line item negotiated charges, the shoppable negotiated charges, de-identified minimum negotiated charge, de-identified maximum negotiated charge, and discounted cash price.
- A comprehensive machine readable file with extensive pricing components
- custom procedure categories & sub categories with ease of use customer decision tree
- Web-hosted with customized facility style and color
- Payer transparency analytics
- Ability to print pricing estimates
Contracts are modeled
for accurate pricing and
Chargemaster third-party negotiated rates, de-identified minimum and de-identified maximum charge, and discounted cash price.
What Was The Purpose For the CMS Mandate?
Recognizing that surprise billing leaves patients feeling stressed out and anxious, CMS price transparency executive order will end ‘balance billing’, where patients are billed the difference between what providers charge and what insurers will pay. These bills often come as a shock, firstly because the patient didn’t expect the bill in the first place and secondly, because the complexities associated with healthcare expenses create opacity around the actual cost of care. e more about your product or service. How can you benefit them?
Our team models hospital providers, third-party and government contracts then work in partnership to customize pre-service pricing which allows them to provide their patients with personalized pricing data before care is delivered.
Revenue Masters combines the cost of services and the payer specific negotiated rates for accurate price transparency. Companies that do not have payer contract modeling software to model payer specific rates will not be able to provide hospitals with accurate pricing for pre-service and shoppable services which places hospitals at risk of providing inaccurate data and loss of revenue.
Healthcare providers need to act now to address this mandate. Additionally, providers will need to develop an integrated strategy that aligns charges, prices and out-of-pocket costs.
All in, transparent pricing is an increasingly useful strategy to improve revenue alongside patient satisfaction.
To see our full suite of contract management services for:
- Contract Management & Modeling
- Denials and Underpayments Management
- Pricing Transparency
- Patient Estimation
- Zero Balance Review & Recovery
- Contract Modeling API
go to www.RevenueMasters.com