The pandemic has changed the way healthcare is delivered, and some of these changes are set to stay even when the Public Health Emergency wanes. In response, the Centers for Medicare and Medicaid Services (CMS) has announced upcoming changes that have a significant impact on both providers and patients.
The new CMS regulations will require continued improvements in communication, delivery of services, billing and many other aspects of the healthcare system. Let’s look at a few of these key regulations and how they will affect the industry in 2021.
Changes to Telehealth Coverage
CMS recently released its Physician Fee Schedule (PFS) final rule, which increases payments to physicians for additional time spent with patients. Starting on January 1, 2021, this rule will ensure that healthcare providers can spend more time with their patients and less time on paperwork. The PFS rule is part of a healthcare movement toward providing accessible and affordable services.
One of the changes it introduces is the expansion of telehealth, the use of telecommunication technology and electronic data with the purpose of supporting remote healthcare. This stemmed from a need to give Medicare beneficiaries in facilities such as nursing homes located in rural areas more options to get the care they need.
The pandemic resulted in an influx of telehealth innovation, and CMS responded by adding 144 telehealth services, including initial inpatient and emergency department visits, that are covered by Medicare. This is a critical step in preventing hospitals from becoming overcrowded while still providing patients with access to the healthcare services they need.
CMS data shows that out of 63 million Medicare beneficiaries, 24.5 million of them used telemedicine services between mid-March and mid-October. The additions to telehealth services will continue to be covered by Medicare for those in rural areas after the pandemic, and more services may be added in the future.
What Providers Need to Know
Patients in rural areas that may not have the broadband access they need can still benefit from phone-only services. In response, CMS will pay the same rates to providers regardless of whether they’re using phone calls or video technology.
Providers can bill CMS for telehealth services by reporting the place of service code that would have been used for the same in-person service. This allows the system to make the appropriate payments for Medicare telehealth services.
Will Telehealth Be Expanding in Other Areas?
For now, the new rule will be limited to those in rural areas. According to CMS Administrator Seema Verma, congressional action is needed for telehealth to become permanent in areas outside of rural regions.
Hospital Price Transparency Rule
Another major CMS regulation, its Hospital Price Transparency rule, is also set to go into effect on January 1, 2021. This rule provides visibility into the cost of a hospital service or item before a patient receives it. The rule required that every hospital in the United States must make its pricing accessible by detailing costs online.
This makes it easier for consumers to compare prices at different hospitals and to have insight into how much a hospital visit will cost them beforehand. Hospital Price Transparency is just one part of a larger plan to provide a better digital experience for patients.
What Does Price Transparency Mean for Hospitals?
Hospitals will have to post their pricing for at least 300 shoppable services prominently on a public website and in a consumer-friendly format. These are services such as outpatient visits, lab tests and X-rays. Posting can be done in one of two ways — a machine-readable file or a display of shoppable services. Those that don’t comply with the new CMS regulations will face warning notices, monetary penalties and requests for a corrective action plan.
What Does Price Transparency Mean for Patients?
CMS’s new rule will enable the public to make well-informed healthcare decisions. Patients will know how much they will be charged for services or items before they receive a bill. This includes patient discounts for cash payments and the rates the hospital negotiates with insurance. Consumers will benefit from price comparison and can use this transparent pricing to find the hospital that fits their budget.
How Can Healthcare Providers Prepare for These Changes?
Changes to the way hospitals provide information to patients require the technology that can enable seamless and secure access to this data. Healthcare providers facing new CMS regulations in this digital age can prepare in a few ways.
Empowering Patients With a Digital Storefront
Technology tools such as a digital storefront will enable hospitals to adhere to price transparency regulations by listing all facilities and providers, along with pricing information. Patients can search for specific services and compare prices before adding those services to their shopping cart, and hospitals can get immediate payment for services.
Using a HITRUST CSF Certified Vendor
When outsourcing fulfillment services, healthcare providers should look for a vendor that is HITRUST CSF certified. This status demonstrates that a company is committed to meeting key compliance requirements, such as Medicare regulations, and protecting sensitive data.
Relying on Electronic Billing and Document Management
Healthcare providers can keep customer documents in a centralized system to enable patients to view invoices, make payments and set up notifications. This reduces the need for manual paperwork and gets patients the information they need quickly.
Adapting to the Changes in Healthcare
Healthcare is changing, and the new CMS requirements will help providers better align with the needs of the public today. These changes mean greater accessibility and more affordable, transparent services.
Healthcare providers face many changes in the upcoming months and need the right tools to adapt to the CMS rule changes in 2021. United Mail has been serving the healthcare industry for more than 40 years. Contact us to learn how our solutions can help you adapt to this new era of healthcare and help you meet CMS regulatory requirements.