CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.
Mr. Cardelle, Chief Strategy at AMS Intelligent Analytics, will focus on:
• An overview of the CMS Final Rule for Hospital Price Transparency & Health Plan Transparency in Coverage requirements, comparing some of the key differences between the two.
• A summary and status of data integrity, compliance with the Final Rule, and an update on the penalties for Non-Compliance.
• An overview of the Hospital Chargemaster (CDM) and the difference between Chargemaster Reconciliation and Chargemaster Validation and why this is important.
• A review of new Payment Integrity and Business Intelligence Use Cases
• Reported Price differences between Hospital published data and Health Plan published data.
Mr. Verrengia, Chief Operating Officer at Northwell Direct, will explore how the newly available Price Transparency information impacts the strategy, approach, and results of contracting for the hospitals & health systems. Areas of focus will include:
• What information and approach are health systems taking to secure this information, what components are most important, and which vendor partners have been most valuable to work with?
• What is the compliance rate for hospital participation in this endeavor and how does the potential for low compliance impact the strategy or negotiation results? What have been the barriers to compliance and why as well as what other challenges exist?
• What has been the experience with the data quality, both in the values and understanding episodic or bundled payments?
• Has the availability of price transparency data been an overall positive to hospital negotiations? If so, how? If not, why not?
• Has Price Transparency changed how hospitals approach pricing methodology and if so, how?
• Do hospitals see Price Transparency accomplishing what it was intended to do?
• What do we see for the future of Price Transparency for hospitals and payers?
Mr. Zhou, Actuarial Manager at Optum, will provide an overview on Machine Readable Files (MRFs) and a walkthrough of a MRF sample with focus on:
• How contract rates are presented and what's missing.
• Why payers are publishing billions of records.
• Removal of duplicates and irrelevant rates.
• An actuarial Use Case.