Date of Award

2022

Degree Name

Healthcare Administration

College

College of Business

Type of Degree

M.S.

Document Type

Research Paper

First Advisor

Alberto Coustasse

Abstract

Introduction: The cost of health care services in the United States (U.S.) varies from state to state and facility to facility. The compilation of such costs and their associated codes is referred to as a chargemaster, or charge description master (CDM), and each is unique to an individual facility. . The implementation of the 2019 Centers for Medicare and Medicaid (CMS) Hospital Price Transparency Rule was an initial step toward consumer empowerment by making services more shoppable but published CDM data failed to present the information most pertinent to patients: total out-of-pocket costs and the availability of lower-cost alternatives. Initiatives in long-term strategies.

The purpose of this research has been to analyze the effect of the 2019 Centers for Medicaid and Medicare Services (CMS) Hospital Price Transparency Rule on the ability of healthcare consumers to shop for hospital services, as well as to examine the effect of the 2019 CMS Rule on the chargemaster billing rates for hospital services.

Methodology: The methodology for this research study was a qualitative study with mixed methodologies that included a literature review and a semi-structured interview with an employee in revenue cycle management at a hospital in Huntington, West Virginia. . The articles were limited to the English language and were published from the years of 2013 through 2021, and 21 citations were used for data abstraction and analysis.

Results: The results of the literature review and interview with a revenue cycle management expert have demonstrated that federal price transparency regulations have not had a positive effect on the Shopability of services for healthcare consumers and have not caused the cost of hospital services to decrease.

Discussion/conclusion: Price transparency for hospital services acted as a step in the right direction for consumer empowerment but further research is needed to explore the implications and efficacy of existing regulations.

Subject(s)

Health services administration.

Health facilities – Business management.

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