More Hospitals, Payers Compliant With Price Transparency Laws

Dive Brief:

• The majority of hospitals are complying with federal price transparency laws that have been on the books since 2021, according to new data from Turquoise Health released on Thursday.
• Ninety-one percent of 6,357 hospitals posted a machine-readable file in 2023 — an increase of 562 hospitals year over year. Over 200 payers posted MRFs in 2023, up from just 67 in 2022, according to the company.
• The progress on price transparency comes after the CMS began cracking down on hospitals for non-compliance. As of September, the agency had issued 1,000 warning notices and 14 civil monetary penalties to non-complying providers, according to the report.

Dive Insight:

The quality of MRFs submitted by hospitals and payers also increased, according to Turquoise. More than half of hospitals that posted MRFs received a five-star rating from the company for publishing complete MRFs with cash, list and negotiated rates for a significant number of services.

Though the federal price transparency rule — which was created to help patients shop for care and drive down medical costs — went into effect in 2021, hospitals and payers have been accused of failing to fully comply with the guidance.

In February of last year, an analysis from PatientRightsAdvocate.org found only a quarter of hospitals were in full compliance with the rules, and 6% of hospitals posted no usable pricing files.

Under the rule, hospitals are required to post information — including standard charges for items and services for all payers and plans — in a consumer-friendly display for the 300 most common procedures. Payers are required to post in-network rates and an allowed amount file containing allowed amounts for, and billed charges from, out-of-network providers.

The CMS toughened up on non-compliance last year. In addition to issuing warnings and civil monetary penalties, the agency also took action to address complaints about unusable public files. In November, the agency announced hospitals will have to standardize charge information to conform to a CMS template, data specifications and data dictionary.

Cumulatively, Turquoise said the changes “represent the most significant changes” to price transparency rules since they went into effect in 2021, and may have spurred hospitals and payers to action.