CMS TRANSPARENT PRICING RULES IN EFFECT

On Jan. 1, 2019, the new Centers for Medicare and Medicaid (CMS) rules, which require health care organizations to post standard procedure pricing information online in a machine-readable format, took effect. CMS proposed and approved these changes to its Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) programs last year.

How do these rules improve transparency?

According to a CMS press release, “[the] proposed policies in the IPPS and LTCH PPS proposed rule would further advance the agency’s priority of creating a patient-centered health care system by achieving greater price transparency, interoperability and significant burden reduction so that hospitals can operate with better flexibility and patients have what they need to become active health care consumers.”

Essentially, these rules make it easier for consumers to have access to health care procedure pricing, making it easier to shop around for the best price. However, consumers should note that the pricing information provided is what a procedure costs, on average, before insurance. And, while efforts will likely be made to keep this pricing information updated, they may not always be accurate.

What does this mean for me?

For consumers, these rules will make it easier for you to be informed about your health care costs. However, you will need to do your due diligence and contact your insurance provider to get the most accurate procedure pricing information as possible.

For health care providers, these rules state that you need to provide the average price of procedures before insurance and post them online in a machine-readable format.

Where can I get more information?

For more information on these rules, please visit the CMS’ website or review the list of FAQs they published on these rules.