Are all hospitals complying with the new Price Transparency Rule?

It seems some healthcare organizations have been paralized and struggling to comply with the price transparency rule which took effect on January 1, 2021.

Studies show top hospitals in the US are inconsistent and incomplete with their pricing information on their websites. 

All the top hospitals published some pricing information but not all the healthcare organizations fully complied with the price transparency requirements set by CMS. For example, some hospitals simply failed to show all the shoppable services as required. 

The price transparency rule in states that hospitals must publish the consumer-friendly list of prices for 300 shoppable services. These services are generally non-emergency services that patients can choose from as well as an overall list of prices for every item and service the hospital provides. 

In addition, there are other common compliance issues including data not being available to download in a usable format for consumers which includes not providing the HSPCS codes for services, and variability in hospital terms for the pricing information. 

In recent studies it seems the hospital price transparency rule may not be as useful as policy makers may have thought. The study found that patients still face problems identifying the common healthcare services despite the price transparency requirements by the CMS ruling. 

To give an example, many services, especially emergency services like heart attacks cannot be planned for in advance. The importance of 3rd party price transparency tools are critical for successful implementation and compliance. 

Furthermore, despite the ruling consumers are not fully aware of their overall financial responsibility, including out-of-pocket expenses if the providers deliver unexpected services during a procedure. 

On behalf of the healthcare organizations they have criticized the new price transparency ruling is ineffective. Hospitals have argued that the requirements could have a negative effect because competitors have the ability to see rates and this may increase prices for consumers.

Regardless of the effect of the price transparency ruling hospitals still must comply with the CMS requirements or face monetary penalties. The failure to comply could result in a fine of up to $300 per day. 

The COVID-19 pandemic is another issue of compliance for hospitals considering the high volumes of patients as well as the need to distribute vaccines. These issues are straining healthcare organizations as a whole.

Given the election of the Biden administration the AHA has urged a reconsideration of enforcement of the price transparency ruling requirements. 

The Biden administration has yet to respond publicly to this issue. 

Discover The Ultimate Pricing Transparency Solution

If you are interested in a free demo of our AllPayor® Software, please go HERE or you can register for a FREE webinar HERE