ST. PAUL, Minn.—February 27, 2020. Panacea Healthcare Solutions, Inc., a company specializing in healthcare coding, compliance, pricing software, and consulting services, announced today that it has developed and launched new pricing transparency readiness software and consulting services to help providers prepare for and comply with the recently expanded Centers for Medicare & Medicaid Services (CMS) Hospital Price Transparency Rule requirements that will go into effect on January 1, 2021.
With these new requirements, your health system must make accessible all standard charges, defined as gross charges and negotiated managed care rates, in a machine-readable format and for consumers as a list of 300 “shoppable” items—non-urgent, high-volume items and services—on your website or via an interactive tool. The intent is to provide an easy way for consumers to determine, in advance, the allowed payment for their prospective service based on their insurance or if with an interactive tool their patient pay obligation and for employers, vendors and payers to have access to the rates with hopes of driving down costs through transparency.
Meeting this requirement will require a significant effort for most health systems, which is why Panacea has developed software tools and consulting services to assist clients.
“Our new Shoppable Disaggregation Algorithm and Report Set will make it easy for hospitals and health systems to process hundreds of thousands of claims and payment data to compile their shoppable 300 list,” said Frederick Stodolak, CEO of Panacea. “Health systems are required to develop a distinct list of items for each of their providers, considering their unique case mix, volume or revenue as well as the 70 items and services CMS has already listed in the final rule. Our new software makes building each of these lists painless by processing 100 percent of the patient population through algorithms utilizing clinical coding and financial logic and proprietary tables to eliminate the records that do not meet the ‘shoppable’ criterion. The software also disaggregates the data into useful categories with tags and filters to facilitate the formation of the shoppable list.”
Once hospitals have built their shoppable 300 list, the next step is to make the information available to consumers through a website display and in a format specified by CMS.
“To help health systems make their information accessible, Panacea has also automated the process of creating the CMS-required machine-readable file and the consumer display of the shoppable list,” said Mark Spehar, Senior Vice President of Financial Services at Panacea. “Because most providers will find it difficult to present, in a consumer-friendly manner, complex managed care rates having multiple provisions, Panacea’s report set goes beyond that required by CMS to provide average payment rate information more meaningful to consumers.”
This software and service is being implemented now in Q1. Panacea has also integrated new functionality into its nationally recognized Hospital Zero-Base Pricing® software that will empower clients to simultaneously create pricing models for the entire chargemaster and the CDM items from the shoppable list while ensuring prices are rational and competitive. Panacea recommends a holistic review of chargemaster prices each year with special attention given to the shoppable items and services.
To download a a copy of the CMS Price Transparency Rule Highlights and Next Steps, click here.
To learn more about this new software and service, give us a call at 866-926-5933.