How Do We Compare Payment Rates Across Health Plans and Hospitals?
Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. We’ve already answered “Why do Hospitals Offer Lower rates to Some Payers?” and “What Is The Relationship Between Insurance Contracts and What Members Pay?” so let’s look at “Why do Hospitals Offer Lower Rates to Some Payers?”
Comparison of payment rates across health plans is a comp...
Negotiation Skills: Impact on Health Plan Terms
A clear sense of current market trends, cost of care, and demonstrated efficiencies that reduce cost are essential elements of contract negotiation preparations.
Negotiation leverage, in terms of hospital control, comes from several sources. The most recognized driver is market power based on geographical area or demographic factors. However, hospital/payer relationships, service offerings needed in the community, and negotiation skill and/or ne...
How hospitals can create cost advantage where product differentiation is not present
A challenge exists in ﬁnding accurate comparative data for bundled-payment arrangements, such as total hip replacement
Cost advantage is necessary when a business is perceived as providing the same products or services as its competitors. In the eyes of many major healthcare payers, hospital services are not perceived as differentiated and are viewed as equally substitutable. While some payers are beginning t...
A RESPONSE TO THE CY22 OPPS PROPOSED RULE (CMS-1753-P) FOR PROPOSED CHANGES TO REQUIREMENTS FOR HOSPITALS TO MAKE PUBLIC A LIST OF THEIR STANDARD CHARGES
Provided by: Cleverley + Associates
The CY22 OPPS Proposed Rule contains additional information and requirements regarding hospital price transparency. The proposed changes relate to current requirements found in CY 2020 OPPS Final Rule on Transparency (CMS-1717-F2).
CURRENT DISCLOSURE REQUIREMENTS SUMMARY:
As a continuation of the FY19 IPPS...