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April 29, 2021

Dear Colleagues,

As you know, the Trump Administration in the FY21 final rule required hospitals to report the median Medicare Advantage payer-specific negotiated charge for each MS-DRG in the Medicare Cost Report.

In the FY22 proposed rule for the Inpatient Prospective Payment System, released earlier this week, this requirement has been RESCINDED.
 

Despite this setback for price transparency, Congress remains committed in its support of price transparency due to the overwhelming support of its constituents.  In fact, 2 weeks ago, Congress sent a strongly worded letter to the new HHS Secretary, Xavier Becerra, urging more price transparency audits and stricter penalties.

In particular, the letter says, "we urge HHS to enforce the final rule to ensure hospitals are fully compliant with the disclosure requirements so that patients can readily access the price information for all items and services in an easy-to-use format. Given the widespread non-compliance by hospitals, we urge HHS to revisit its enforcement tools, including the amount of the civil penalty, and to conduct regular audits of hospitals for compliance."

A recurring complaint is that hospitals are not complying with the price transparency rule in showing all of the customary items and services that accompany an outpatient surgery:



 


Hospital Pricing Specialists has a national Outpatient Service Group® database that FULLY complies with the aforementioned language in the Federal Register. The key difference is that an Outpatient Service Group® shows an outpatient surgery charge on a CLAIM LEVEL as opposed to a LINE-ITEM LEVEL.  The national OSG® database includes 4,914 hospitals and 4,888 unique Outpatient Service Group® codes.

In addition, the OSG® database is case-mix adjusted with HPS's proprietary and patent-pending Outpatient Case Mix®.  

If you need help with price transparency and/or would like a sample OSG® report, send me an email or I'm happy to jump on a quick call.


Regards,

Rick Louie
Managing Director
Hospital Pricing Specialists LLC

LinkedIn Profile:  https://www.linkedin.com/in/ricklouie/

Watch video of Shark Tank's Mr. Wonderful endorsing HPS Price Transparency services [Click Here]



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