Price transparency has been a hot topic over the past few years. It all began with the Hospital Price Transparency Rule, which was passed in 2020 just as the COVID-19 pandemic began to complicate the health care industry.
This legislation went into effect in 2021, and since then, hospitals are slowly beginning to revise their websites and print materials to comply. In that time, the Centers for Medicare and Medicaid Services have completed their own audits of the pricing figures at over 800 hospitals. Early on, CMS analysts found discrepancies in third-party reviews, leading them to keep closer tabs on the process.
Due to the results of the initial legislation, the health care industry has since awaited a related policy – the Insurer Price Transparency Rule – that now extends to health insurance companies and their reimbursement rates.
This newer legislation further contributes to the goal of more accessible and, hopefully, more affordable medical care for patients. Legislation for the Insurer Price Transparency Rule was passed around the same time as the hospital-based rule. However, the initial phases of the newer policy didn’t go into effect until July 2022. The final stages of this rule are expected to be enacted by the end of 2024.
But many people have been wondering how this more recent legislation is working so far. Experts are finding the answer depends on what you’re looking for. Most pricing data health insurers make available is in-network instead of out-of-network, since insurers often negotiate between various providers for in-network figures. Research shows that Blue Cross Blue Shield, Kaiser Permanente, United Healthcare, and Aetna are among the 240 insurers complying with this legislation.
To get an idea of the most recent results of this legislation, it’s best to compare them to the current outcomes of the Hospital Price Transparency Rule. As of December 2022, health insurers named over $56.5 billion in-network negotiated prices while hospitals reported $1.8 billion. However, there is quite a large difference between these results, which seems to suggest newer legislation is either being better enforced or taken more seriously among insurers than it is by hospitals.
In order to guarantee initial or continued compliance with this legislation, insurers should look to those they partner with. A key way for organizations to ensure their own adherence to the Insurer Price Transparency Rule is by urging their provider networks (including clinicians and medical facilities) to identify their in-network status.
This is an important first step that is most often done by reporting their unique National Provider Identifiers (NPIs) if they are independent providers or employer identification numbers (EINs) if they are practice owners. These moves can not only help insurers establish a better relationship with their members, but also work more efficiently with their provider networks.