The rule, which applies to about 6,000 hospitals, also requires them to provide in an online, searchable way the rates for 300 common services, such as X-rays, outpatient visits, Cesarean deliveries and lab tests. In addition, hospitals must disclose the amount they are willing to accept in cash.
Hospitals that don’t comply will face a civil penalty of up to $300 a day. The Centers for Medicare and Medicaid Services said it will start auditing hospitals this month.
Rule may mean more confusion for consumers
The American Hospital Association last month wrote to the Joe Biden transition team asking the incoming administration to exercise discretion in enforcing compliance with the rule and to evaluate whether it should be rescinded.
“Whichever way that issue is resolved in consultation with your administration, now is not the time to heap these requirements on hospitals that need to keep their focus and resources devoted to caring for patients and administering vaccines,” wrote Richard Pollack, the association’s chief executive officer.
Some health policy experts doubt the rule will reduce costs or save patients’ money. The theory is that patients will visit the hospital websites and choose lower-priced options, which will lead to competition in the US health care system and drive prices down.
“To date, the evidence is that that does not work,” said Ateev Mehrotra, an associate professor of health policy at Harvard Medical School who has studied price transparency efforts.
When insurers have provided pricing tools — with more personalized cost information — few people have used them.
Also, it will likely be difficult for consumers to use hospitals’ pricing lists since there can be multiple medical codes involved for each service, such as an X-ray or MRI, he said.
Insurers must disclose out-of-pocket costs in 2023
A separate rule, which was made final in October and takes effect in 2023, requires insurers to provide an online shopping tool that allows consumers to see negotiated rates with providers and gives them estimates of their out-of-pocket costs for 500 of common shoppable items and services.
The following year, insurers must show all remaining procedures, drugs and other items.
This measure was prompted by feedback that consumers are more interested in what they are on the hook for based on their insurance plans’ deductibles and copays.
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