What Is Price Transparency Pertaining To The Healthcare Industry?

The healthcare industry has been one of the most important ones for our economy and humanity as a collective. Relying on healthcare services and professionals is a basic human need, making these establishments irreplaceable. Not only do we as consumers heavily rely on these organizations for their treatment and recovery, but also invest in them. These investments are poured into the fields of research and development, technological adaptations, and the improvement of mobile healthcare services. Moreover, digital healthcare is on the rise, giving us an opportunity to receive the best care from top professionals.

However, transparency in the healthcare sector is one of the biggest debates of all time. Considering the state of healthcare providers, insurance companies, and medical costs surging, price transparency is the need of the hour. The Centers for Medicare and Medicaid Services (CMS) has seen the disparity and come up with two rules to help everyone involved. But how can we bring forth more transparency with the help of these rules, and what are these rules? Let’s find out all about it in this blog!

What is meant by price transparency?

Price transparency in the healthcare industry refers to making clients and patients feel better prepared, informed, and considered in their journey through hospitalization and similar services. Even though a few service providers already are well on their way to showcasing estimated billing amounts for select services and procedures before the healthcare is provided, we cannot consider medicare in the same bracket as other services or goods.

The healthcare industry has services that are pretty expensive to receive and render. They are also made up of confusing and personal decisions, which involve the risk of life-long consequences. As per statistics, a large number of US citizens, 50% of whom have been to college don’t have an adequate understanding of the healthcare system. This hinders their ability to effectively traverse their healthcare benefits and insurance. The impact of price transparency in healthcare today will change the way these customers go about receiving and paying for the services received. One of the reasons why we need price transparency is the consumer’s inability to do their own research and find out what they’re paying for; whether it is a fair service provided or if they are being ripped off.

To help clients and patients enhance their knowledge of healthcare costs, The Centers for Medicare and Medicaid Services (CMS) have released two final rules. While one discourses hospital price transparency, the other covers transparency in healthcare coverage.

Both of these rules aim to bring better engagement with the customers so that they are present in every step of their healthcare decisions and not just spectators in their own investments.

US regulations for price transparency

We all know how the healthcare policy changes in the US have been made to create cost detailing in this industry for stakeholders and patients. Authorities and business leaders are optimistic that these policies will aid in the reduction of the staggering medicare prices and streamline the high-tech quality of healthcare.

As per the Hospital Price Transparency Final Rule, each healthcare establishment or hospital in the United States is expected to:

  1. Release accurate and easily available pricing details for 300 “buyable” healthcare services. These details must be released online and need no login or personal health information (PHI) of the visitors to offer user-friendly information.
  • Release a file  (machine-readable) that comprises the rates of all their mental healthcare services (including but not exclusive to shoppable services).

Since this rule went into effect on the 1st of January, 2021, there are consequences for non-compliance. Failure to adhere to the Hospital Transparency Rule will attract penalties of USD 300 per day for breaking the rules. There are solutions that these organizations can use to quickly adapt and avoid non-compliance fines.

Preventing surprise medical bills

The United States Department of Health and Human Services (HHS) released a new rule on the 1st of January, 2022 concerning the No Surprises Act. It is  designed to protect the financial interests of consumers from surprises and unexpected or hidden costs in their medical bills, and the provisions are:

  1. Emergency services will be treated as in-network services.
  2. A permanent ban on exuberant out-of-network healthcare cost-splitting systems for emergency and regular services.
  3. A ban on out-of-network services for subordinate care provided at in-network hospitals.
  4. Providing clear context regarding out-of-network healthcare charges to patients in advance.

Final Word:

Now that you know more about the Price Transparency rules’ role in the healthcare industry, we’re hoping it helps consumers turn out to be more informed in their medical decisions. Not only will this create vigilant consumers, but also forewarn medical establishments regarding the cost of no transparency. For more news on the healthcare industry’s latest, stay tuned to our blog section.