The Hospital Price Transparency Rule

Healthcare is expensive, even when you have insurance. The Centers for Medicare & Medicaid Services (CMS) predicts that healthcare spending will make up 20% of the United States economy within the next five years. A federal mandate implemented on January 1, 2021, aims to shine the light on the real price of a hospital stay, and help consumers make informed healthcare choices.

The Federal hospital price transparency rule, part of the Affordable Care Act, requires hospitals to provide standard charges including the rates they negotiate with insurance companies and the discounted price a hospital is willing to accept directly from a patient if paid in cash. The information must be publicly available, free of charge, and presented in a consumer-friendly display.

These standard charges include over 300 services that can be planned in advance, along with a description and any other services the hospital customarily provides with it. Prices for services such as imaging, laboratory testing, and outpatient procedures such as a colonoscopy are also provided. The average consumer may find the information a bit difficult to comprehend, however.

The price transparency rule requires five different prices for each of the common procedures.

• gross charge- the charge for an individual item or service that is reflected on a hospital’s chargemaster, absent any discounts
• payer-specific negotiated charge- the charge that a hospital has negotiated with a specific third party payer (e.g., single insurance company) for an item or service. This price may be different for each insurance provider
• de-identified minimum negotiated charge- lowest charge that a hospital has negotiated with all third party payers (e.g., insurance companies) for an item or service.
• de-identified maximum negotiated charge- highest charge that a hospital has negotiated with all third party payers (e.g., insurance companies) for an item or service
• discounted cash price- the charge that applies to an individual who pays cash (or cash equivalent) for a hospital item or service

While this may seem like information overload, the transparency rule does require consumer friendly search parameters. You won’t have to input any personally identifiable information. You can search by service description, billing code, and insurance provider. Searches can be conducted for inpatient and outpatient services, and searches are limited to one facility at a time. You’ll have to take notes to compare prices between providers.

Learning about cost before receiving care puts more power in the hands of the patient. When you combine this with the ability to learn about care standards of hospitals, Americans now have powerful tools to select the best healthcare options available to them. This will have ripple effects throughout the healthcare system as providers adapt to attract educated and price conscious consumers.

When it comes to your imaging needs, Watson Imaging Center is a smart choice for patients who prefer convenience and personal service at a great price. For bone density exams, x-ray or ultrasound imaging, you only need to make one call. Watson Imaging Center (314) 781-9711. Proudly serving greater St. Louis.