Price Transparency and No Surprises Act: Details You Need to Know to be Prepared

As if an ongoing global pandemic wasn't enough, healthcare organizations have faced nearly insurmountable changes in the healthcare space over the past 18+ months. Some of the changes were temporary under the public health emergency and allowed us to care for patients with less 'red tape'. While other changes feel more like an administrative burden during these uncertain times.

Health systems and standalone clinics alike, feeling the strain of long hours and reduced staff worked to implement CMS' Price Transparency final ruling in late 2020 and throughout 2021. This ruling requires qualifying organizations to publish two machine readable data sets. The first, a searchable file of standard charges including a minimum of 300 billable services while the second file includes detailed reimbursement amounts in order to provide a shoppable experience for those seeking health care. With price transparency , providers must get used to the idea that information previously held close to the chest will now be on public display. For providers that don't comply, CMS has begun imposing corrective action plans which will result in monetary fines upwards of $5,000 per day based on facility size.

The next big challenge facing us is the No Surprises Act, which is set to become effective January 1st, 2022. Understanding the requirements in this new federal law and educating revenue cycle staff will be critical to ensuring your organization is reimbursed appropriately, and most importantly, conducting self pay billing practices in a compliant manner.

During this webinar, we'll review CMS regulations and what’s required from providers for both Price Transparency and the No Surprises Act. We'll review strategies for implementation of both and talk about how CMS is currently responding to providers that haven't complied with Price Transparency requirements yet.