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New Healthcare Price Transparency Rule to Unveil Negotiated Rates

Getting blood checked


(RevCycle Intelligence) – A final healthcare price transparency rule from HHS will require hospitals to post payer-specific negotiated rates and other charges by 2021.

“President Trump has promised American patients ‘A+’ healthcare transparency, but right now our system probably deserves an F on transparency. President Trump is going to change that, with what will be revolutionary changes for our healthcare system,” HHS Secretary Alex Azar said in an official announcement.

He went on to say that the two rules “may be a more significant change to American healthcare markets than any other single thing we’ve done, by shining light on the costs of our shadowy system and finally putting the American patient in control.”

The finalized hospital price transparency comes days after it was noticeably absent in the final 2020 Outpatient Prospective Payment System (OPPS) rule. This separate final rule dubbed the 2020 OPPS & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public Final Rule confirmed that HHS will move forward with requiring hospitals to publish negotiated rates despite industry push back.

HHS first proposed the hospital price transparency requirement in July 2019. Hospitals and payers opposed publishing negotiated rates online and called on HHS to abandon the proposal or possibly face legal action.

Hospitals, however, will not only have to publish gross charges and payer-specific negotiated charges, as proposed, but also discounted cash prices, the de-identified minimum negotiated charge, and the de-identified maximum negotiated charge for all items and services provided by the hospital, according to the final rule.

The information will also have to be made public in a machine-readable format online. Three hundred “shoppable” services will also need to be “displayed and packaged in a consumer-friendly manner.”

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