Price Transparency Rules - DoctorsManagement Price Transparency Rules - DoctorsManagement

Price Transparency Rule

May 3, 2021

by Sean Weiss, Partner & VP of Compliance

In January 2021, a Price Transparency rule went into effect and swept in a new era in health care. The rule issued by the US Department of Health and Human Services (HHS) requires hospitals to make public their cash and insurance negotiated rates. These must be posted on their hospital website and must be in a very simple access format. Failure to post fees results in a fine (Note – physicians are exempt from having to post fees on websites).

The 2nd rule will take effect January 2022 and forces insurers to disclose their negotiated contracted rates! This puts the power in the hands of consumers and, much like any other service, allows you to shop for the best deal. Open competition is just what the doctor ordered.

Physicians will benefit significantly from these new rules since patients will finally see that going to an independent doctor versus one employed or owned by a hospital is as cheap if not cheaper. Hospitals, private equity groups and insurance companies are not happy since they profit the most from hiding their rates. Physicians will finally be able to take back control of their practice and return to a level of financial freedom not seen in decades!

Transparency in Coverage Final Rule Fact Sheet (CMS-9915-F)

What to do next…

  1. If you need help with an audit appeal or regulatory compliance concern, contact us at (800) 635-4040 or via email at info@drsmgmt.com.
  2. Read more about our: Total Compliance Solution

Why do thousands of providers trust DoctorsManagement to help improve their compliance programs and the health of their business?

Experienced compliance professionals. Our compliance services are structured by a chief compliance officer and supported by a team that includes physicians, attorneys and a team of experienced auditors. The team has many decades of combined experience helping protect the interests of physicians and the organizations they serve.

Quality of coders and auditors. Our US-based auditors receive ongoing training and support from our education division, NAMAS (National Alliance of Medical Auditing Specialists). All team members possess over 15 years of experience and hold both the Certified Professional Coder (CPC®) as well as the Certified Professional Medical Auditor (CPMA®) credentials.

Proprietary risk-assessment technology – our auditing team uses ComplianceRiskAnalyzer(CRA)®, a sophisticated analytics solution that assesses critical risk areas. It enables our auditors to precisely select encounters that pose the greatest risk of triggering an audit so that they can be reviewed and the risk can be mitigated.

Synergy – DoctorsManagement is a full-service healthcare consultancy firm. The many departments within our firm work together to help clients rise above the complexities faced by today’s healthcare professionals. As a result, you receive quality solutions from a team of individuals who are current on every aspect of the business of medicine.