healthcare pricing, Price Transparency

The Price Transparency Rule & Non-Compliance of Major Hospitals

Around two-thirds of the largest hospitals in the US are yet to fully comply with the new price transparency rule, with most of the hospitals missing payer-specific charges. The new price transparency rule went into effect on January 1, 2021.

Where the Hospitals are Lacking?

According to recent research, nearly two-thirds of the 100 largest hospitals in the country by certified bed count did not meet all the criteria of the new rule, and most of them were missing out on posting payer-specific negotiated charges on their website. Only 22 percent of the hospitals seemed to be fully compliant with the requirements of the new price transparency rule, some exceeding the regulation in terms of the amount of pricing information shared on their websites.

Price Transparency

How is the Compliance Established?

A hospital is compliant with the new rule if their files were machine-readable and contained detailed information regarding gross charge, discount cash price, payer-specific negotiated charges, de-identified minimum and maximum charges, description, and codes for the items and services provided by the hospital.

In the case of payer-specific negotiated charges, the hospitals are needed to reveal both the name of the payer and plan to be compliant with the rule.

The Future of Non-Compliance

Around 82 percent of the non-compliant hospitals either did not reveal the payer-specific negotiated rates with the name of the payer and the plan or were non-compliant in some other ways. The remaining 18 percent of the non-compliant hospitals did not post any files at all, or their databases were not compatible.

CMS will be auditing the hospital websites soon to ensure compliance with the rule, and the hospitals could be fined up to $300 per day for non-compliance.

Hospital groups throughout the country have been in a fight to prevent the price transparency rule compliance since HHS finalized it in 2019. The AHA even led a lawsuit challenging the requirements of the rule, which was eventually rejected by an appeals court.

Research has shown that price transparency in healthcare has led to lower prices for consumers. However, industry leaders have been criticizing the rule and its requirements as they feel that it could increase healthcare prices by reducing competition on the market.

At a time when hospitals across the country are fighting against the price transparency rule, companies like Health Beyond Insurance (HBI) are all about transparency. They help patients focus on their health, while the providers can concentrate on their specialties and not on insurance. While experts provide healthcare at a fixed rate, surgeons offer heavily discounted cash prices for maximum convenience. The country needs such companies to ensure better health for its citizens.