While many things in our daily lives have changed in the first half of 2020, one thing remains constant. The Hospital Outpatient Prospective Payment System (OPPS) final rule from Medicare focusing on Pricing Transparency is coming, along with its deadlines and requirements.
If you missed our article from the beginning of the year ‘Pricing Transparency: We’ve Got Your Road Map for 2020’, I recommend reading it for an in depth look at the requirements and some early advice to get you started on your way to meeting the January 1, 2021 deadline.
Being halfway through 2020, we wanted to check in to make sure you are on track to meet letter and spirit of the law. Here are some quick questions to help you self-assess:
- What current estimate capabilities does my organization possess?
- Have we identified our 300 shoppable services?
- Do we have a delivery method identified for perspective patients to shop? Estimate vendor, EHR – Guest Estimates, web tool, etc?
- Do we have a project and resources in place to implement the delivery method?
- Do we have a plan to train staff on how to discuss estimates with patients in an effective and compassionate way?
- Are you making the most of the change necessary by improving your payment collection processes and patient financial experience?
The answers to these questions will help you understand where you stand at meeting the requirement, and allow you to place yourself on our pricing transparency maturity model:
If you are behind in meeting the requirements or don’t like where you find yourself on the transparency maturity model, it’s not too late. Here are the items you need to focus on in the short term to meet the letter of the law and begin transforming your front-end payment collection processes and workflows:
- Executive Order Compliance
- First and foremost, ensure you are meeting the letter of the law by January 1, 2021
- Shoppable Services Implementation
- Implement technology to allow patients to shop for your defined set of services
- MyChart and Guest Estimate Implementation
- If you have Epic, leverage guest estimates to allow perspective patients to shop
- Patient Estimate Template Roadmap
- Have a comprehensive plan in place to ensure the building blocks of your pricing transparency initiatives is in place
- Payment Collection Reporting
- Set up accountability structures and requisite reporting to monitor estimate generation, collection, and accuracy
- Patient Education and Communication
- Create effective marketing tools and train staff to educate patients on their payment options and responsibility
If you could use help developing your plan and executing the changes before the January 1, 2021 deadline, we’d love to help. At The Wilshire Group we developed a Pricing Transparency project to get you there. Our team of Epic and industry experts can help you optimize your use of Epic, build out estimates, increase front-end collections, and improve your patient’s financial experience. If you would like to learn more about our Pricing Transparency offering, please reach out to Matt Perron and Freeman Jenkins.