Rising healthcare costs are a major concern for American families and businesses alike. In recent years, there has been an increased focus on the role of transparency in healthcare pricing. Treatment cost information should be readily available and easily accessible to patients so they can make informed decisions about their care.
Healthcare price transparency is a necessary first step in empowering consumers and reducing healthcare costs. By making treatment cost information readily available, patients will be able to compare and shop for the best value. This will pressure providers to compete on price, driving down the cost of care. In addition, by making informed choices about their care, patients will be less likely to overuse or misuse healthcare services, which will also help to bring down costs. It is clear that healthcare price transparency is good for both consumers and the overall healthcare system.
Patients in the United States are in the dark about the cost of their health care until after they obtain services and receive a bill until July 1st, 2022. to the Center for Medicaid and Medicare Services (CMS), these requirements empower consumers to shop and compare costs between specific providers before receiving care. Consumers need meaningful information in a readable format to create a competitive market that lowers costs and improves healthcare outcomes.
Beginning July 1, 2022, health plans will start to post on its website and make prices for covered services available to its members. Healthcare price transparency gives patients the information and cost of a covered service before receiving care. According to the Center for Medicaid and Medicare Services (CMS), The Transparency in Coverage rules go into effect in stages, with enforcement beginning on July 1, 2022, and more requirements will enhance patient’s pricing shopping, and comparison choices will go into effect starting on January 1, 2023, and January 1, 2024.
- The Readable Files:
- The provision requires health plans to provide files in a format that is readable and contains the following sets of costs for items and services.
- In-Network Rate File: Health plans will post and make available prices or rates of covered services between in-network providers and health plans.
- Allowed Amount File: Health plans will post the allowable amounts for services and the billed charges from out-of-network providers in a readable format.
- Internet-based price comparison tool or disclosure on paper upon request by a consumer. Individuals can receive an estimate of their cost-sharing responsibility for service from a specific provider(s) for 500 items and services.
- Internet-based price comparison tool or disclosure on paper upon request by a consumer. Individuals can receive an estimate of their cost-sharing responsibility for service from provider(s) for all items and services.
CMS will enforce corrective action and/or impose a civil money penalty p to $100 per day, per individual, and per violation.