Price Transparency for Rural & Community Hospitals
To prepare financially for the rising costs of healthcare, patients want to know how much hospitals charge for their needed services, not just the insurance company. However, it’s now more than a patient desire – it’s a requirement for all hospitals, including rural and community hospitals.
Since January 1, 2021, the Hospital Price Transparency Rule by the Centers for Medicare & Medicaid Services has mandated that all U.S. hospitals post online annually their standard charges for goods and services in two formats:
- A comprehensive machine-readable file (MRF)
- A consumer-friendly display including at least 300 shoppable services
In 2024, CMS announced new price transparency requirements to ensure data in the MRF is true, accurate, and complete. With these new requirements, hospitals must use a template issued by CMS with standardized definitions and terminology.
These changes will be rolled out between now and January 2025 and will be enforceable by January 2025.
Our experienced and rural-focused consultant team partners with rural and community hospitals to create fully compliant price transparency files. Using our expertise in price transparency and the rural marketplace, we can help hospitals meet CMS requirements and remain in compliance each year. If a rural or community hospital receives a violation notice from CMS, Stroudwater will partner with the hospital to correct the violation and ensure compliance.
CASE STUDY
See how Stroudwater Helped Alleghany Health Remediate their Price Transparency Issues.
Improving Price Transparency in Rural & Community Hospitals
Developing or modifying price transparency can be a complex process. Many rural & community hospitals struggle to identify 300 shoppable services for inclusion in the list. Additionally, it can take a significant team effort among many departments in the hospital to develop the final transparency documents. When embarking on this journey, whether by choice or because CMS sent a warning, hospital leadership may find themselves asking questions like:
- Who can help to remediate the issues?
- How much would Remediation Cost?
- Is 90 days (or however long the time received by CMS to remediate) enough time to complete the project?
- How will the Rural and Community Hospital withstand the fine if it came to that?
Our team is here to help hospitals update their price transparency affordably and timely. Our two-step process helps rural & community hospitals correct any issues and improve price transparency to have a listing that meets CMS’s requirements.
Develop a Consumer-Friendly Display with at Least 300 Shoppable Services
We will also help ensure that the price transparency list follows standard naming conventions and includes the proper data elements.
- Using the hospital and clinical chargemasters
- Working with Clinical teams for associated ancillary services
- Analyzing payor contracts for payor-specific negotiated charges to be listed for each service
- Developing an Excel model to be posted on the website
- The 70 CMS-specific shoppable services that are provided by the hospital.
- Associated ancillary services provided by the hospital to reach the 300 shoppable service items.
- All locations operating under a single hospital license.
- All required data elements.
- Posted on a publicly available website.
- Easily accessible.
- Digitally searchable.
Develop a Machine-Readable File
We will also help ensure that the machine-readable file:
- Includes all standard charges for all items and services for all locations operating under a single hospital license.
- Is posted on a publicly available website.
- Is easily accessible.
- Is digitally searchable.
- Is updated at least once annually.
- Follows a standard naming convention.
- Contains the correct data elements.
- Is properly reflected in the appropriate location
Comprehensive MRFs and shoppable service files contain similar yet unique information. Having a partner like Stroudwater Associates to help modify or develop price transparency in a rural or community hospital can ensure the CMS requirements are met promptly in the event of a violation notice.
