Complying with price transparency is hard...but what if it isn't?
The timing of price transparency regulation (transparency for hospitals, transparency for payers) was never going to be convenient. It's like asking someone when they want to go to the dentist. But there is a way to make compliance easy and, dare I say, fun.
So far, the price transparency final rules have proven to be administrative burdens on par with “52 card pickup” and “5000-piece puzzle of photo of grass.”
We’re right there with you - over the past year, we’ve helped hospitals organize their PDFs, contract matrices, and historical claims data - all geared around meeting the Price Transparency compliance requirements. After a few laps around the track, we’re happy to announce a shortcut option for organizations that don’t enjoy sadistic data wrangling.
Introducing One Click price transparency
Here’s how it works for providers:
- Your team provides data in the standard input format below, along with a historical claims export
- Our software crunches the numbers
- We output a 1) CMS-compliant standard charges file, 2) CMS-compliant white-labelled patient estimate tool, 3) Optional Turquoise Verified marketplace-facing hospital page and patient estimate tool, 4) Ongoing market benchmark reports by region, payer and provider type throughout the year
- Everyone gets like 1,000 hours added back to their year
- Patients are more empowered to know their cost of care
We know there can be some prep work required for step 1. To use a cooking analogy, there might be veggies to chop before we can start cooking. We’ll partner with you during the prep to help create a sustainable process so that the following year is truly One Click. That way, when the time comes to renew your compliance, the veggies come pre-chopped.
Here’s the catch: we have an input specification (links below)
We know our way around managed care agreements, fee schedules and claims data. We also know how to produce large, machine-readable files and consumer-friendly browsing experiences.
But in order for us to create a sustainable, ongoing price transparency workflow for you, we’re particular about our data formats. See our documentation in both PDF & Excel format below, and make sure to reach out to us before completing so we can give you a few additional pointers. Providers can ensure a simple, sustainable compliance process by building their contract matrices using our templates, or by using Turquoise Health's contract management module (just email us about that).
A note on payer price transparency (CMS 9915, Transparency in Coverage)
Payer rules for price transparency were finalized in October, 2020. The rules resemble the hospital regulation while extending to a much wider swath of data.
Turquoise provides white-labelled payer price transparency page, as well as assistance in creation of machine readable files. There is more to our payer offering than just "One Click" and we encourage you to reach out for a demo.
Our thesis here is: "If this software is already built, there's no need to build it again."
Machine-readable files for January 1st, 2022:
- In network all service file. Includes: negotiated rates for all covered items and services between the plan or issuer and in-network providers.
- Out of network historical file. Includes: historical payments to and billed charges from out-of-network providers.
- Pharmacy file. Includes: in-network negotiated rates and historical net prices for all covered prescription drugs by plan or issuer at the pharmacy location level
Patient Estimator requirement, starting January 1st, 2023:
- 500 specified services 1/1/23 (give us a ring for an Excel of that list)
- All services by 1/1/24 (even pharmacy)
Get transparent easy way
Questions? Reach out to: firstname.lastname@example.org