Reduce Medical Bills

Hospital Price Transparency: What to Know (and How to Get Help)

April 20, 2022

Resolve Team

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Have you heard the recent buzz around hospital price transparency? Back in January of 2021, the official CMS Hospital Price Transparency rule went into effect for hospitals across the nation in the hopes of a more transparent way forward for hospitals, and fewer frustrated and overwhelmed patients with medical billing issues. Yet, the majority of hospitals have yet to comply, still leaving patients in the dark around healthcare pricing in general. 

So, what exactly is happening here, and how can you get help if you’ve found yourself in a frustrating medical bill situation due to lack of hospital price transparency? In this article, we’ll discuss what the hospital price transparency provisions are, what consumers should know, and how to get help lowering your medical bills if you are affected. Let’s dive into the details below. 

What is the Hospital Price Transparency Rule?

Put simply, the hospital price transparency rule aims to provide Americans with more transparent prices on hospital items and services before they receive their bill. The Centers for Medicare and Medicaid Services (CMS) policy, which went into effect on January 1, 2021, requires health systems to publicly post the costs of their items and services online. 

The CMS policy provisions state that hospitals must provide this information in two ways:

  1. A comprehensive machine-readable file with standard charges for all items and services the hospital provides 
  2. A consumer-friendly display of their 300 most common shoppable services 

And, what is supposed to happen if hospitals don’t comply? The CMS states that they will “issue a warning notice, request a corrective action plan, and impose a civil monetary penalty and publicize the penalty on a CMS website.” However, compliance with the regulation has been lacking among hospitals since the rule went into effect. 

Preparing for Transparency in Coverage Rule for July 2022

In addition to this rule, additional CMS policies are set to be issued later this year regarding transparency in coverage. The CMS is further tightening the rules to provide complete price transparency for consumers so they can better understand the costs associated with their healthcare and make better informed decisions. 

The Transparency in Coverage rule will go out in stages. However, beginning July 1, 2022, most group health plans and issuers of group or individual health insurance will start to post pricing information for covered healthcare items and services. 

What Does Healthcare Price Transparency Mean for Patients? 

Both the Hospital Price Transparency and Transparency in Coverage rules are positive steps in the right direction, although they don’t yet solve the issues and frustrations around outrageous medical bills. These healthcare price transparency efforts are helping consumers stay more informed about their healthcare costs before receiving their medical bill. 

The ultimate goal of hospital price transparency is to help consumers more easily shop around, compare hospital prices, and better estimate their medical costs before a hospital visit. So, you can now know what hospitals will charge you for the care and services you receive well before you get that dreaded and confusing medical bill. 

As the consumer and patient, you can: 

  • Review your potential costs and plan in advance 
  • Stay informed and armed with your medical pricing data 
  • Shop around by comparing prices of multiple hospitals, so you can find the one that works best for you

Where Compliance is Lacking for Hospital Price Transparency

As we mentioned earlier, despite this rule going into effect well over a year ago, hospitals are still not complying. In fact, according to a recent report, less than 20% of hospitals are in compliance with this rule. That’s right, even though corrective action plans and penalties may be issued, a mere 14% of hospitals are in compliance with the Hospital Price Transparency policy. Studies show that compliance is lacking more so for machine readable files than for the shoppable services requirement. 

So, if hospitals aren’t complying, and confusing medical bills still continue to land in patients’ laps, how can you get help resolving your medical bill issues? 

How to Get Help with Medical Billing Issues 

For starters, you can go directly to the CMS with a complaint, but you can also get help from medical bill advocates and experts like Resolve. 

Hospital Price Transparency Help from CMS 

To get help from CMS, you can: 

  • Submit a complaint if it appears that a hospital has not published their prices anywhere online
  • Contact CMS for other questions regarding Hospital Price Transparency and compliance 

Help Fighting Overwhelming Medical Bills from Resolve

If you have a confusing medical bill and need answers around your healthcare costs and how to get your medical bills lowered, you can turn to a medical billing advocate at Resolve. Our mission is to make healthcare bills fair and to help patients during the most frustrating of circumstances. We’re just as tired about these unfair practices and the excuses hospitals have made as to why they haven’t complied with the Hospital Price Transparency federal regulation. 

At Resolve, we can: 

  • Get you a fair price analysis on your medical bills 
  • Negotiate your hospital bills 
  • Check for billing and coding errors
  • Appeal your health insurance claim 
  • Help you easily apply for hospital financial assistance 

…and much more. 

You shouldn’t be in the dark anymore; we’re here to help. Contact us at Resolve if you’re dealing with hospital pricing issues and would like to see how we can help, or schedule your free consultation now with one of our expert advocates. 

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