Presenters Highlight Price Transparency Tools to WHA Task Force

November 07, 2019

The WHA Transparency Task Force (TTF) reconvened Oct. 30 to hear presentations from various organizations that have developed tools to simplify patient billing and improve cost transparency. Presenters from electronic health records leader Epic Systems described their current focus on collecting feedback around patient convenience and estimate accuracy to improve system capabilities. Epic is also working to improve automation and making realtime cost information available to providers. TTF members asked about capabilities such as producing provider and site-specific estimates, queries to determine whether providers are in-network, and also asked about time frames for system implementation.

Health Payment Systems (HPS), another Wisconsin-based entity, described their work with employers and providers to produce consolidated, easy-to-understand bills for patients.

Finally, a team from TruBridge, a revenue cycle software used widely by WHA members, described their capabilities to comply with current and proposed federal regulations pertaining to price transparency. TruBridge also described their ability to provide real-time eligibility verification, provider-specific cost estimates and plain-language information to patients.

The TTF also heard from WHA Director of Federal and State Relations Jon Hoelter, who provided an update on the state and federal landscape as it relates to surprise billing, as well as WHA’s advocacy efforts. He noted WHA led another delegation to Washington, D.C. on Oct. 29 to discuss surprise billing and met with lawmakers and/or staff from every Wisconsin office. Hoelter said WHA’s message was again well-received, but the fate of federal legislation that would include government-set commercial rates to resolve balance billing disputes remains uncertain. While most lawmakers believe the federal proposal is unlikely to come up before the end of the year, others suggested it could be included as part of a larger end-of-year government spending package.

Hoelter also gave an overview of WHA’s comments on the proposed transparency mandates in the Centers for Medicare and Medicaid Services (CMS) outpatient payment rule. He noted that CMS’ proposal to require hospitals to post negotiated rates was likely illegal, and that the American Hospital Association intends to file litigation to block it. While the outpatient final rule was released on Nov. 1, CMS set aside the transparency provisions to be finalized at a later date. (See related story.)

The final meeting of the TTF is scheduled for Dec. 5, when the group will review a draft report documenting best practices and policy recommendations of the Task Force. For more information about the TTF, contact WHA Vice President of Public Policy Lisa Ellinger.

This story originally appeared in the November 07, 2019 edition of WHA Newsletter