CMS Price Transparency 2021: What PTs Need to Know

Learn what the price transparency final rule is for 2021. Discover what PT's should know about medical price transparency at Healthie.

National healthcare spending has risen tremendously in recent years, and in response to this, the federal government enacted a policy to increase spending awareness. In 2019, CMS finalized the plans for this new policy: The Price Transparency, that would push America toward a more “patient-driven healthcare model.” 

The purpose of the policy is to increase the transparency of healthcare spending and improve patients' knowledge on what and how much they pay for services provided to them from hospitals. The Final Rule for the Price Transparency went into effect on January 1st, 2021. 

Below we summarize the 2021 CMS Price Transparency Final Rule and how it will impact you as a physical therapy provider. 

Who Does This Policy Impact?

The Price Transparency Final Rule impacts all hospitals operating in the United States with exception to those that are federally operated (ie. VA hospitals).  

What is the Purpose of the 2021 CMS Price Transparency Final Rule?

The CMS Price Transparency Final Rule states that:

Each hospital operating in the United States will be required to provide clear, accessible pricing information online about the items and services they provide. 

With this medical price transparency policy, hospitals are now required to provide a comprehensive machine-readable file with all items and services. They must also have a consumer-friendly format of the shoppable services they provide.  

Updates must be made to the hospitals list of items and services that they provide and the standard charges associated with each item and service must occur annually.

There are five different standard charges that CMS defines: 

Gross Charge: The charge for an individual item or service that is reflected on a hospital's chargemaster, absent any discounts. 

Discounted Cash-Price: The charge that applies to an individual who pays cash or cash equivalent, for a hospital item or service.

Payer-Specific Negotiated Charge: The charge that a hospital has negotiated with a third party payer for an item or service.

De-Identified Minimum Negotiated Charge: The lowest charge that a hospital has negotiated with all third-party payers for an item or service. 

De-Identified Maximum Negotiated Charge: The highest charge that a hospital has negotiated with all third-party payers for an item or service.  


Role of Physical Therapy Services

Items and services provided by a hospital inpatient or outpatient can be separated into different categories, one of them being shoppable services. A shoppable service is a service that can be scheduled in advance to the consumer receiving it.  Physical therapy is considered a shoppable service, due to  patients being able to make appointments to attend physical therapy prior to the day they require it. 

Physical therapy can also be considered an ancillary service. An ancillary item and service is defined by CMS as an item or service that a hospital customarily provides as part of or in conjunction with a shoppable primary service. For example, if a patient has a total knee arthroplasty surgery, physical therapy would be an ancillary service because they would automatically receive physical therapy post surgery.

How CMS Price Transparency Will Affect Physical Therapy Providers

Patients will now be able to look up and see the prices and copays of the hospital services and items that they are receiving. Patients will be informed now more than ever on where their money is being spent when they pay a hospital bill. Due to this, patients may start to compare quality of services and prices amongst different providers. 

It is important that physical therapists strive to improve the quality of the care they provide every single day. Staying up to date with the latest research/techniques and engaging in continuing education classes can help you and your staff not only provide better care but also leverage you against your competitors. 

Patients want to go to a provider that they trust will provide them with the best quality of care possible. Now that patients are more informed about the prices of physical therapy services, they may be more apt to change providers if they feel that the quality of care does not match the price of the services they are paying for. 

Patients deserve to know where their finances are going when they receive hospital services. It is up to you as physical therapists to educate them through the process and show them that they are receiving the high standard of care they deserve. 
Ultimately, the hope is that with the knowledge gained through this price transparency policy, individuals will take greater responsibility in their healthcare journey and that overall healthcare spending will decrease.

Healthie for Physical Therapists

Healthie offers a cloud-based EHR and telehealth platform that is quick to implement while supporting compliance with HIPAA regulations — while being customizable to meet your business needs. In addition, the Healthie platform integrates with insurance billing tools, so that you can quickly create Superbills and CMS 1500 claims, send invoices, and collect payments for out-of-pocket services. 

Here’s what you gain when working with your physical therapy or occupational therapy clients via Healthie: 

  • Insurance Billing
  • Online scheduling
  • Anatomical Charting and document library 
  • Patient Engagement
  • Reporting and KPI tracking
  • And much more

We have seen physical therapists and occupational therapists find success using Healthie within their practices. Whether you’re a solo practitioner or part of a multi-provider group or organization, our flexible membership plans adapt to meet your business needs. Let us help you launch your practice.

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Focus on clinic growth and patient care with Healthie.

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Health software that makes a difference

Focus on clinic growth and patient care with Healthie.

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