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Penrod Blog

Outpatient Prospective Payment System

What do the new provider price transparency requirements mean for you?

You may have already heard the news about additions to the Outpatient Prospective Payment System (OPPS). The Centers for Medicaid and Medicare Services announced that hospitals will be required to post payer-negotiated prices in an online portal by 2021.

You can read more about the 2020 Outpatient Prospective Payment System (OPPS) law in detail here.

We’re also anticipating that payers will be mandated to publish online cost details. Here are the high-level details of the mandate that was announced by the White House on November 15th:

  • The portal must include payer-negotiated rates for 300 shoppable services (we’ll post the list as soon as it’s available).
  • The format must be convenient. Think mobile friendly, accessible, and easy to use.
  • The information must be easily searchable. We interpret this as “Please, don’t just post a bulleted list.”

So, how can payers and providers address this impending regulation – and avoid the inevitable fines that result?

Before you panic, think about this. While government regulations can impose challenging timelines on your already highly-regulated business, we view this as an opportunity to engage your patients in meaningful new ways that will ultimately transform your business and increase revenue.

Think about it:

  • It’s already best practice. Many providers and payers are already providing prices for procedures and services, and the transparency helps them market their services to new patients. If you aren’t doing it, you should be for the revenue opportunity.
  • It requires a small, relatively insignificant percentage of your overall revenue. And, we’re convinced that proper implementation of the rule will drive enough revenue to make up for the cost.The regulation compels you to:
  • Evangelize your brand in new ways.
  • Engage with your patients in new ways to increase stickiness.
  • Design and market high-deductible plans more effectively. As healthcare costs are shifted to consumers, price transparency is the key to helping them make informed decisions about their care.

Now that the timeline has been set, how should you plan your implementation?

  • The doer: If you’re working with a consultant, pick a partner that has experience in implementing healthcare-oriented, HIPAA compliant solutions – and ask them for references.
  • The workhorse: Pick a platform that has a strong reputation not only in healthcare, but also user experience.
  • The timeline: Don’t start from scratch. Select a system that is easily configurable to ensure you meet the deadline and avoid fines.
  • The future: Ensure you have the keys to the castle. Your system needs to be usable by your staff for ongoing maintenance and updates.

Here at Penrod, we think we have the ideal fit for full compliance with the new regulation in the Outpatient Prospective Payment System. Using the power of Salesforce Communities, we can build a system that:

  • Meets the requirements of the mandate
  • Is HIPAA compliant
  • Allows you to engage with your patients to increase stickiness
  • Is completely white-labeled, ensuring your brand is the star
  • Can be implemented quickly
  • Is built by a leader in solutions for healthcare

Ready to get started?

Let's talk compliance

Get in touch with Penrod.