Hospital Transparency

by David Mordo
Hospital Transparency

When: Effective January 1, 2021

How: Each hospital operating in the United States will be required to provide clear, accessible pricing information online about the items and services they provide in two different ways:

1. As a comprehensive machine-readable file with all items and services. This includes:

  • Gross charges - Charges are referred to as full or gross charges if they have not been adjusted in any way, and are the top rate billed to any patient or insurer when a fee scale or contract is not in place.
  • Cash prices - The cash pay price is the price you pay in full before a medical procedure. Paying the medical cost before the time of service can mean significant savings to you.
  • Payer-specific negotiated charges - The payer-specific negotiated charge (the charge that a hospital has negotiated with a third-party payer for an item or service). The de-identified minimum negotiated charge (the lowest charge that a hospital has negotiated with all third-party payers for an item or service.)

2. In a display of the 300 most shoppable services that a consumer would normally schedule in advance. The format must be consumer-friendly and include the same information as above. 

Why: This information will make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital. There are potential penalties in place for hospitals that do not comply. Hospitals can be fined $300 per day and would be listed on CMS’ website as “non-compliant.”


Source: https://www.federalregister.gov/documents/2019/11/27/2019-24931/medicare-and-medicaid-programs-cy-2020-hospital-outpatient-pps-policy-changes-and-payment-rates-and
 

Get More from Healthcare Exchange

Subscribe today to stay up-to-date on the latest healthcare reform news, tools and resources.



© 2021 BenefitMall. All rights reserved. BenefitMall, the BenefitMall Logos, and NEXT GENERATION BROKER SERVICES are trademarks or registered trademarks of Centerstone Insurance and Financial Services, Inc. d/b/a BenefitMall or its affiliates in the U.S. California License #0639679. *All other trademarks are the property of their respective owners.