Wednesday, April 21, 2021
This post is part one of two in a series on new transparency requirements impacting both health plans and health care providers.
In an effort to assist patients in understanding the cost of hospital services, the Hospital Price Transparency rule at 45 C.F.R. § 180.10
et. seq., effective January 1, 2021, requires all hospitals to make public the following pricing information:
A comprehensive machine-readable file containing the following: a. A description of each item or service provided by the hospital. b. The gross charge that applies to each individual item or service. c. Payer-specific negotiated rates that apply to each item or service for which a payer negotiated rate has been established. Each payer negotiated price must be clearly associated with the name of the applicable third-party payer and plan.
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“Would you like Wednesday or Friday?” the medical scheduler asked.
That simple question catches many people flat-footed. It’s easy to take it at face value, look at your calendar and determine which date you prefer for a needed surgery. In my case, it was an arthroscopic surgery for a torn meniscus one of the pieces of cartilage in the knee that, when damaged, can cause significant pain and swelling.
But there are consequences to selecting a surgery date that go beyond the block of time on your calendar. For me, there was about $11,000 hanging in the balance.
That’s because behind the question of Wednesday or Friday was the issue of where the surgery would take place. On Wednesdays my orthopedic surgeon practiced at his affiliated hospital. On Fridays he performed procedures at the outpatient surgery center located literally across the street. The cost for his work was about the same at both locations, but the facility fees at the hospital led to a price tag that was abo
What is the Hospital Price Transparency rule?
Healthcare costs some of the most significant expenses in our lives have historically been unknown and unavailable to consumers until the bill arrived. With the Hospital Price Transparency Rule, instituted on January 1, 2021, you ll be able to see more costs ahead of time.
There are two phases to the rule. Phase one requires hospitals to publish their prices online. According to the Centers for Medicare & Medicaid Services, Hospitals must post standard charges for at least 300 shoppable services that can be planned in advance, such as x-rays, outpatient visits, imaging and laboratory tests or bundled services such as a colonoscopy. Hospitals will be charged a penalty of $300 a day for noncompliance.
Lubbock hospitals unveil online pricing tools in line with new transparency rule
Lubbock hospitals unveil online pricing tools in line with new transparency rule By Brittany Michaleson | January 19, 2021 at 8:30 PM CST - Updated January 19 at 8:30 PM
LUBBOCK, Texas (KCBD) - The pandemic isn’t the only reason some people are skipping out on medical care.
A 2020 survey reports nearly 1 in 4 Americans say they have steered clear of some sort of medical care because of the expense.
The federal Hospital Price Transparency rule went into effect at the beginning of the year, as required by the Centers of Medicare and Medicaid Services.