Health Catalyst, Inc · NASDAQ:HCAT
Health Catalyst — Conference Presentation (2024)
36 slides from Health Catalyst's conference presentation, Sep 17, 2024
Slide 1: What’s Next for Hospital Price Transparency in 2024 and Beyond
What’s Next for Hospital Price Transparency in 2024 and Beyond © Health Catalyst. Confidential and Proprietary.
Slide 2: Presenters
Jennifer Bishop, RHIT, CCS, CCS-P, CHRI VP, Vitalware Product Content Stacey Jenkins Chief Compliance Officer Corporate Counsel © Health Catalyst. Confidential and Proprietary.
Slide 3: Disclaimer Statement
Disclaimer Statement This webinar/presentation was current at the time it was published or provided via the web and is designed to provide accurate and authoritative information regarding the subject matter covered. The information provided is only intended to be a general overview with the understa
Slide 4: Agenda
Current Hospital Price Transparency Requirements Agenda New Requirements for Display of Hospital Standard Charges and Defined Timeframes for Compliance New Requirements to Improve Enforcement Questions References © Health Catalyst. Confidential and Proprietary.
Slide 5: Current Hospital Price Transparency Requirements
Current Hospital Price Transparency Requirements © Health Catalyst. Confidential and Proprietary.
Slide 6: Current Hospital Price Transparency Requirements
Current Hospital Price Transparency Requirements • Beginning January 1, 2021, the Hospital Price Transparency Final Rule established requirements for hospitals to make public their standard charges in two ways: • As a comprehensive machine-readable file • Single machine-readable digital file contain
Slide 7: Current Hospital Price Transparency Requirements
Current Hospital Price Transparency Requirements • Information must be posted to a publicly-available website • Information must be displayed in a prominent manner and clearly identified with the hospital location associated with the information • Information must be easily accessible without barrie
Slide 8: Current Hospital Price Transparency Requirements
Current Hospital Price Transparency Requirements • CMS monitors for compliance through their own audits and through complaints received from individuals or entities • Hospital non-compliance is addressed through CMS actions • Written warning notice of specific violations • Request for corrective act
Slide 9: New Requirements for January 1, 2024
New Requirements for January 1, 2024 © Health Catalyst. Confidential and Proprietary.
Slide 10: New Requirements for January 1, 2024
New Requirements for January 1, 2024 Good Faith Effort Each hospital must make a good faith effort to ensure that the standard charge information encoded in the machine-readable file is true, accurate, and complete as of the date indicated in the machine-readable file. © Health Catalyst. Confide
Slide 11: Requirements to Improve Automated Access to the MRF - January 1, 2024
Requirements to Improve Automated Access to the MRF - January 1, 2024 A .txt file in the root folder (base URL of the website) that includes a standardized set of fields Hospital location name that corresponds to the MRF The source page URL that hosts the MRF A direct link to the MRF (the MR
Slide 12: New Requirements for July 1, 2024
New Requirements for July 1, 2024 © Health Catalyst. Confidential and Proprietary.
Slide 13: New Requirements for July 1, 2024
New Requirements for July 1, 2024 Require display of standard charge information using a CMS Template layour in .json or .csv format, data specifications, and data dictionary Template, data dictionary, and other technical instructions can be found at github https://github.com/CMSgov/hospital-pri
Slide 14: Required Data Elements – July 1, 2024
Required Data Elements – July 1, 2024 General data elements Hospital name(s) – Legal business name of the hospital Hospital license number(s) and two-letter state code issuing the license Location name(s) and addresses(es) under the hospital license number – Location names and addresses must
Slide 15: Required Data Elements – July 1, 2024
Required Data Elements – July 1, 2024 Standard Charge data elements Gross Charge – The charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts Discounted Cash – The charge that applies to an individual who pays cash for a hospital item or s
Slide 16: Required Data Elements – July 1, 2024
Required Data Elements – July 1, 2024 Standard Charge data elements Payer Name – The name of the 3rd-party payer that is legally responsible for payment of a claim for a healthcare item or service Plan Name – May be indicated as categories (e.g., all PPO Plans) when payer-specified negotiated
Slide 17: Required Data Elements – July 1, 2024
Required Data Elements – July 1, 2024 Item & Service data elements General Description - The description of the item or service that corresponds to the standard charge the hospital has established. Setting - The place where the item or service is provided for the associated standard charge amo
Slide 18: Required Data Elements – July 1, 2024
Required Data Elements – July 1, 2024 Coding data elements Billing/Accounting Codes - Any code used by the hospital for purposes of billing or accounting for the item or service Code Type – Used to clarify type of billing or accounting code – Current Procedural Terminology (CPT) - All Patient
Slide 19: Required Data Elements – July 1, 2024
Required Data Elements – July 1, 2024 Affirmation in the MRF CMS-defined affirmation statement in the MRF that the information displayed is true, accurate, and complete as of the date indicated in the file – Required Statement: To the best of its knowledge and belief, the hospital has included a
Slide 20: New Requirements for January 1, 2025
New Requirements for January 1, 2025 © Health Catalyst. Confidential and Proprietary.
Slide 21: Required Data Elements – January 1, 2025
Required Data Elements – January 1, 2025 Estimated Allowed Amount - The average dollar amount that the hospital has historically received from a 3rd-party payer for an item or service Required when the standard charge methodology is percentage or algorithm CMS will allow hospitals flexibility
Slide 22: Required Data Elements – January 1, 2025
Required Data Elements – January 1, 2025 Drug Information Drug Unit of measurement - The unit value that corresponds to the established standard charge for drugs Drug Type of Measurement - The measurement type that corresponds to the established standard charge for drugs as defined by either t
Slide 23: Required Data Elements – January 1, 2025
Required Data Elements – January 1, 2025 Modifier Code - Two-digit code Modifier Description – The common name of the modifier Modifier Payer Information – Description of how the modifier may change the standard charge for the specified payer/plan – For example, modifier 50 applies 150% change
Slide 24: Optional Data Elements
Optional Data Elements © Health Catalyst. Confidential and Proprietary.
Slide 25: Optional Data Elements
Optional Data Elements Financial Aid Policy – Information may be displayed as a description or as a link to the financial aid policy on the hospital’s website Billing Class – The type of billing for the item or service Valid Values: Professional, Facility, or Both © Health Catalyst. Confidenti
Slide 26: Monitoring and Assessment
Monitoring and Assessment © Health Catalyst. Confidential and Proprietary.
Slide 27: Only CMS can make a determination as to a hospital’s compliance
Only CMS can make a determination as to a hospital’s compliance with the Hospital Price Transparency requirements © Health Catalyst. Confidential and Proprietary.
Slide 28: Monitoring and Assessment Changes
Monitoring and Assessment Changes Addition of activities that may be used to monitor and assess for compliance CMS may conduct a comprehensive compliance review of standard charge information posted on a publicly available website Use of audits will be retained Upon request, CMS may require
Slide 29: Monitoring and Assessment Changes
Monitoring and Assessment Changes Expansion of publicized information related to hospitals’ compliance CMS’ assessment of a hospital’s compliance Any compliance action taken against the hospital The status or outcome of the compliance action Notifications sent to health system leadership ©
Slide 30: Questions?
Questions? Jennifer Bishop hcwebinars@healthcatalyst.com © Health Catalyst. Confidential and Proprietary.
Slide 31: References
References © Health Catalyst. Confidential and Proprietary.
Slide 32: Implementation Timeline
Implementation Timeline MRF INFORMATION Requirement Regulation Cite Implementation Date MRF Date 45 CFR 180.50 (b)(2)(i)(B) July 1, 2024 CMS Template Version 45 CFR 180.50 (b)(2)(i)(B) July 1, 2024 HOSPITAL INFORMATION Requirement Regulation Cite Implementation Date Hospital Name 45 CFR 180.50 (b)(2
Slide 33: Implementation Timeline
Implementation Timeline STANDARD CHARGES Requirement Regulation Cite Implementation Date Gross Charge 45 CFR 180.50 (b)(2)(ii) July 1, 2024 Discounted Cash 45 CFR 180.50 (b)(2)(ii) July 1, 2024 Payer Name 45 CFR 180.50 (b)(2)(ii)(A) July 1, 2024 Plan Name 45 CFR 180.50 (b)(2)(ii)(A) July 1, 2024 Sta
Slide 34: Implementation Timeline
Implementation Timeline ITEM & SERVICE INFORMATION Requirement Regulation Cite Implementation Date General Description 45 CFR 180.50 (b)(2)(iii)(A) July 1, 2024 Setting 45 CFR 180.50 (b)(2)(iii)(B) July 1, 2024 Drug Unit of Measurement 45 CFR 180.50 (b)(2)(iii)(C) January 1, 2025 Drug Type of Measur
Slide 35: Implementation Timeline
Implementation Timeline OTHER HOSPITAL PRICE TRANSPARENCY REQUIREMENTS Requirement Regulation Cite Implementation Date Good Faith Effort 45 CFR 180.50 (b)(2)(ii) January 1, 2024 Affirmation in the MRF 45 CFR 180.50 (b)(2)(ii) July 1, 2024 Text File 45 CFR 180.50 (b)(2)(ii)(A) January 1, 2024 Footer
Slide 36: Helpful Websites
Helpful Websites Hospital Price Transparency - https://www.cms.gov/hospital-price-transparency/hospitals Hospital Price Transparency Resources including Machine Readable File Formats and Data Dictionary - https://www.cms.gov/priorities/key-initiatives/hospital-price- transparency/resources CY 2024 O