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Price Transparency and What it Means for Your Organization

Posted by Tessa Tinley on Nov 29, 2018

Healthcare Price TransparencyPrice transparency consistently ranks as one of the top factors for consumers satisfaction, yet the healthcare industry continues to have some of the most obscure pricing structures in the American economy. According to research by InstaMed, 91% of patients are demanding greater transparency. Because of this phenomenon, CMS and other payers are demanding that providers give their patients more accurate information about costs. This is especially important for healthcare providers who want to take advantage of a changing market where patients are becoming more responsible for paying for their own care. Increasing the transparency of billing will be absolutely crucial for their revenue cycle.

Current Transparency Requirements

When the Affordable Care Act was passed nearly a decade ago, several price transparency regulations went into effect. Each care provider was mandated to create, update, and make public a list of commonly available products and services and their prices. This mandate also applied to diagnostic related groups. While this regulation was an important step forward for pricing transparency, the law did not describe any specific methods for providers to publish this information. This meant that patients only benefited from transparency when they requested specific data directly from organizations.

New Regulations and Proposed Changes

Starting in January 2019, regulations will require that healthcare providers post a list of their standard pricing on the Internet. CMS and other government groups are also proposing further changes to the law. Specifically, they want to change surprise billing practices where patients receive invoices for previously unknown services provided by out-of-network doctors and professionals. Emergency room visits also need a lot of improvement as patients are often surprised by the cost of care received in the ERs throughout the country.

Request for Information

In order to improve transparency standards, CMS sent out a survey to healthcare stakeholders. Questions included those related to topics such as the definition of standard charges, pertinent information for patients, disclosure of out-of-pocket costs, and the enforcement of transparency regulations. Government officials expect that the information provided by this survey will help construct an initiative for better price transparency. Healthcare organizations are encouraged to be as accurate and forthcoming as possible since greater patient satisfaction will likely directly lead to increased revenue.

While the healthcare industry has a long way to go in price transparency improvements, each healthcare provider can take steps on their own to increase the quality and quantity of pricing information available to their patients. One way many healthcare providers are doing this is to outsource their billing practices. Healthcare billing experts often have enhanced tools that enable them to effectively communicate cost information to patients, improving overall patient satisfaction. It's also important for organizations to pay close attention to coming changes in the law.


Topics: Healthcare, Pricing