The Hospital Price Transparency Rule was enacted in 2021 with the goal of making hospital prices more transparent for patients. The rule requires hospitals to post their standard charges, negotiated rates, and cash prices for 300 common services online in a machine-readable format.
However, more than two years after the rule went into effect, many hospitals are still not in compliance. According to a recent report by PatientRightsAdvocate.org, only 36% of hospitals are fully compliant with the rule. This mark is up from the report released in February showing 24.5% compliance. There are several reasons why hospitals are failing to comply with the price transparency rule. Some hospitals simply do not have the resources to comply with the complex requirements of the rule. Others may be reluctant to post their prices because they fear that it will lead to lower prices.
The lack of compliance with the price transparency rule is a major problem for patients. Without access to accurate pricing information, patients are unable to shop around for the best prices on medical care. This can lead to patients paying significantly more than they need to for their care. In recent months, the Centers for Medicare & Medicaid Services (CMS) has begun to crack down on hospitals that are not in compliance with the price transparency rule. CMS has issued warning letters to hospitals that are not in compliance, and it has also begun to impose civil monetary penalties on hospitals that are repeat offenders.
It is still too early to say whether CMS’s enforcement efforts will be successful in getting hospitals to comply with the price transparency rule. However, clearly the lack of compliance with this important rule is a major problem for patients.
What Are the Price Transparency Rules?
The Price Transparency Rules are a set of regulations that require hospitals to publicly post the following information for 300 common services:
- Gross charges: The full price of a service before any discounts or negotiations.
- Payer-specific negotiated rates: The rates that hospitals have negotiated with specific payers, such as insurance companies.
- De-identified minimum and maximum negotiated rates: The minimum and maximum rates that hospitals have negotiated with payers, with the names of the payers removed.
- Discounted cash prices: The prices that hospitals charge patients who pay cash.
- Out-of-pocket cost estimator: A tool that allows patients to estimate their out-of-pocket costs for a specific service.
The rules also require hospitals to post the prices of their shoppable services in a consumer-friendly format. Shoppable services are services that patients can typically choose between different providers, such as an MRI or a colonoscopy.
No Surprises Act Vs. Price Transparency Rule
The rule that is often confused with price transparency is the No Surprises Act. The No Surprises Act is a federal law that went into effect on January 1, 2022. The law prohibits surprise billing, which is when patients are unexpectedly billed for more than their insurance will cover after receiving emergency services or non-emergency services at an out-of-network facility.
The No Surprises Act and the Price Transparency Rules are both important pieces of legislation that aim to make healthcare more affordable and transparent for patients. However, they are two different laws with different goals. The No Surprises Act is designed to protect patients from surprise bills, while the Price Transparency Rules are designed to give patients more information about the prices of healthcare services.
It is important to understand the difference between these two laws so that patients can be aware of their rights and make informed decisions about their healthcare.
Here is a table that summarizes the key differences between the No Surprises Act and the Price Transparency Rules:
|No Surprises Act
|Price Transparency Rules
|Protects patients from surprise bills
|Gives patients more information about the prices of healthcare services
|Applies to emergency services and non-emergency services at out-of-network facilities
|Applies to 300 common services, including both in-network and out-of-network services
|Effective date January 1, 2022
|Effective date January 1, 2021
|Enforced by the Department of Health and Human Services (HHS)
Enforced by HHS and the Centers for Medicare & Medicaid Services (CMS)
Why Are the Price Transparency Rules Important?
The Price Transparency Rules are important because they give patients more control over their healthcare costs. By knowing the prices of different services, patients can shop around for the best deals and avoid paying more than they need to for their care.
The rules also help to promote competition among hospitals. When hospitals are forced to make their prices public, they are more likely to offer lower prices to attract patients. This can lead to lower healthcare costs for everyone.
How To Comply with Price Transparency Rule
Here are some specific steps that medical facilities can take to comply with the Hospital Price Transparency Rule:
- Gather the necessary pricing information. This information should include the gross charges, payer-specific negotiated rates, de-identified minimum and maximum negotiated rates, and discounted cash prices for all the items and services that the facility provides.
- Format the pricing information in a machine-readable file. This file must be in a format that can be easily read by computers. There are several different file formats that can be used, such as XML or JSON.
- Create a display of shoppable services in a consumer-friendly format. This display should be easy for patients to understand and should include the pricing information for a list of 300 shoppable services.
- Post the pricing information on the facility’s website. The pricing information must be posted in a way that is easy for patients to find and understand.
- Monitor the pricing information for accuracy. The pricing information should be reviewed on a regular basis to ensure that it is accurate and up to date.
By following these steps, medical facilities can comply with the Hospital Price Transparency Rule and help patients make informed decisions about their healthcare.
The Price Transparency Rules are a significant step towards making hospital prices more transparent for patients. However, there are still some challenges to overcome. For example, some hospitals are not yet in compliance with the rules, and the information that is posted is not always accurate or complete.
Despite these challenges, the Price Transparency Rules are a valuable tool for patients who are trying to make informed decisions about their healthcare. By understanding the prices of different services, patients can shop around for the best deals and avoid paying more than they need to for their care.