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compl iance&VAl ue
2023 is the year when clarity will finally be achieved with new regulations such as price transparency and the No Surprises Act.
Yet, it will still be difficult for some hospitals to fully implement these new regulations to the government's satisfaction
It's not just about avoiding fines. Hospitals will need to find innovative ways to not only comply with regulations, but to provide increased value to the patient in a competitive market.
REVISED MOON, IM AND DND RECEIVEOMB APPROVAL
On January 23, 2023, the Office of Management and Budget (OMB) approved three revised forms that are required by April 27, 2023. Those three revised forms are:
- Medicare Outpatient Observation Notice (CMS-10611)
- Important Message from Medicare (CMS-10065)
- Detailed Notice of Discharge (CMS-10066)
The revisions involved adding standardized nondiscrimination language required on forms and notices The original content and intent of the notices remain unchanged The new forms and instructions can be accessed in the PDE under t he Advisor tab
Withtheintroductionof theNoSurprisesAct,PriceTransparencyfor theinsuredindividual has becomeconfusedwiththeGoodFaithEstimatefor theuninsuredindividual.
It?s important to understand the difference of an estimate generated for an individual under the Price Transparency law and an uninsured individual under the No Surprises Act Price Transparency Tool (PTT) The PTTis a patient-facing online tool meant to be used by patients who are shopping for services prior to scheduling. These individuals can be insured or uninsured
The desired service must be available as a shoppable service to generate an estimate with the PTT Although generating an estimate for services involves a variety of contractual discounts and health insurance plan information, the PARA Price Transparency Tool (PTT) allows the patient to determine their cost from the provider-based web portal
More information about the PARA PTTcan be found at this link:
PARA Price Tranparency Tool - Sept 2021 pdf (para-hcfs com)
UNDERSTANDINGESTIMATESIN PRICETRANSPARENCY &NO SURPRISES
PARA Dat a Edit or (PDE) Charge Quot e
When the patient is having trouble accessing or navigating the PTT, or the desired service is not a shoppable service, the Charge Quote tab of the PARA Data Editor (PDE) can be used by PDEUsers to generate a quote These quotes are not mandated by any laws, but the benefits of providing cost estimates prior to scheduled services include:
- Providing price transparency
- Providing estimates prior to service, avoiding unexpected financial liability
- Reducing Patient dissatisfaction directed at the provider
- Increasing self-pay collections while decreasing bad debt
The Charge Quote tool is available to PDEUsers under the Charge Quote tab
