A recent Part B news article noted that on Oct. 29, the Centers for Medicare and Medicaid (CMS) announced a final rule on transparency coverage requiring insurers to provide accurate prices for health care procedures. This is a fair step in the right direction, since healthcare providers also need to comply with a separate CMS ruling for price transparency.

Starting in January 2022, all payers will have to make their data files prices available to the government, and the prices will be available to patients via tools such as a new Compare site called “Care Compare, which includes visit cost estimate information for new and returning Medicare patients” where they can “see how much their visit may cost for specialists in their area to help inform their health care decisions,” the announcement says.

Starting January 2023, 500 shoppable services must be displayed on insurers websites. All shoppable services must be displayed as of January 2024.

The rule is a joint regulatory item put forth by HHS, the U.S. Departments of Labor and the Treasury and the IRS. The regulation does not require any significant additional responsibilities for healthcare providers. However, healthcare providers who are receiving higher reimbursement amounts may have to defend these rates with a higher quality of service in the market to remain competitive.

We believe that CMS should require a level of price transparency for healthcare services from insurers. This will help level the playing field amongst healthcare providers and insurers.

Resources
Final rule, pre-publication: www.cms.gov/CCIIO/Resources/Regulations-and-Guidance/Downloads/CMS-Transparency-in-Coverage-9915F.pdf

CMS, Oct. 29, “Fact sheet: Transparency in Coverage Final Rule Fact Sheet (CMS-9915-F)”: www.cms.gov/newsroom/fact-sheets/transparency-coverage-final-rule-fact-sheet-cms-9915-f