Change Healthcare Helps Providers Comply with CMS Price Transparency Rule

The goal is to help providers comply with CMS regulations by providing consumer-friendly pricing information and online healthcare shopping solutions

NASHVILLE, Tenn.--(BUSINESS WIRE)--Jan. 12, 2021-- Today, Change Healthcare (Nasdaq: CHNG) highlighted two options to help providers meet the new CMS price transparency requirements. The Transparency module for the company’s online healthcare eCommerce solution, Shop Book and Pay™, lets patients view pricing for shoppable healthcare services from multiple providers, helping make the process of shopping for healthcare as easy as online retail shopping. The Clearance Estimator Patient Direct solution provides financial estimates for a patient’s out-of-pocket cost for visits, tests, and procedures. Both options also allow patients to view the hospital’s complete pricing data for all services, presenting them with valuable comparison data and giving providers a single-vendor solution to help comply with all CMS transparency regulations.

The CMS Hospital Price Transparency Final Rule requires hospitals to publish a machine-readable file of their standard charges for all services. The deadline was Jan. 1, 2021. This data includes the gross charge, discounted cash price, payer-specific negotiated charges, and the de-identified minimum and maximum charges negotiated with all third-party payers, as well as relevant billing codes and the physical location of each service. Hospitals must also provide potential patients with an online price estimator tool or consumer-friendly searchable list for 70 CMS-specified shoppable services, plus 230 provider-chosen shoppable services. As noncompliant hospitals face daily fines of $300 per location, health systems nationwide are in urgent need of technology to help them meet both CMS requirements.

By creating a convenient digital storefront for potential patients, the Shop Book and Pay™ solution helps providers compete in the marketplace and differentiate their business in a crowded market. Patients can conduct a search for a specific procedure, selecting their insurance provider and plan to receive a list of available locations and full pricing information. With implementation of the Book and Pay modules, the patient can select an appointment time and complete pre-payment up front, before care is given. Clearance Estimator Patient Direct allows patients to search for common procedures and services via their provider’s website. Using historic procedure charge data coupled with real-time, patient-specific benefit data, the solution returns a personalized estimation of the patient’s out-of-pocket cost.

“According to recent consumer research conducted by Change Healthcare and The Harris Poll, more than half of consumers have avoided seeking healthcare because they weren’t sure what the cost would be,” said William Krause, vice president of the Connected Consumer Health™ solution at Change Healthcare. “The CMS rule is intended to remove that uncertainty and empower consumers to make more informed choices. We help providers not only to comply with the CMS rule, but also to create a seamless digital patient experience.”

To get started with the Shop Book and Pay™ solution, organizations should contact Change Healthcare as soon as possible to begin the implementation process. Health systems can either provide their own charge summary data or receive assistance in consolidating payer contracts from a Change Healthcare consultant. Change Healthcare customers who are already live on Clearance Estimator can contact their account management team for details on how to implement Clearance Estimator Patient Direct.

“Price transparency is going to accelerate healthcare’s consumerism trend,” said Steve Mach, director of Patient Financial Services at Halifax Health. “Providers will need to leverage pricing strategies in order to compete for consumers, and we plan to do that by partnering with Change Healthcare on Shop Book and Pay.”

For more information about how Change Healthcare can support your hospital’s compliance with the CMS Price Transparency rule, visit our Price Transparency in Healthcare site.

About Change Healthcare

Change Healthcare (Nasdaq: CHNG) is a leading independent healthcare technology company, focused on accelerating the transformation of the healthcare system through the power of the Change Healthcare Platform. We provide data and analytics-driven solutions to improve clinical, financial, administrative, and patient engagement outcomes in the U.S. healthcare system. Learn more at

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Katherine Wojtecki
External Communications
Change Healthcare

Source: Change Healthcare Inc.