Payer price transparency is the practice of making public the negotiated rates that health insurance companies pay for medical services. In 2023, there will be several updates to payer price transparency requirements. These updates include: CMS proposed new rules in April; dozens of payers have posted accessible and complete price transparency data; two senators asked CMS to address loopholes; new requirements for payers under CMS’ Transparency in Coverage Rule took effect Jan. 1, and researchers have found limitations to the effectiveness of payer price transparency data.
Payer price transparency is the practice of making public the negotiated rates that health insurance companies pay for medical services. This information can help consumers shop for care and make informed decisions about their health.
In 2023, there will be several updates to payer price transparency requirements. These updates include:
1. CMS Proposed New Rules in April
The Centers for Medicare & Medicaid Services (CMS) proposed two new rules in April that would establish national standards of care provided through fee-for-service Medicaid/CHIP and managed care plans, along with a requirement to publicly disclose provider payment rates online.
2. Dozens of Payers Have Posted Accessible and Complete Price Transparency Data
According to Turquoise Health, a company that develops price transparency software, 48 payers have posted accessible and complete price transparency data since requirements for payers to publish negotiated rates took effect in July 2022. The data posted by these payers includes information about the negotiated rates that payers pay providers for covered items and services.
3. Two Senators Asked CMS to Address Loopholes
Democratic Sen. Maggie Hassan and Republican Sen. Mike Braun sent a letter to CMS in April, asking the agency to address loopholes in its price transparency rule for payers. The senators cited recent reports that say some payers have published data in confusing formats that omit important information. They also said the published data is “too large for anything but a supercomputer to process.”
4. New Requirements for Payers Under CMS’ Transparency in Coverage Rule Took Effect Jan. 1
Since the beginning of 2023, payers have been required to provide an internet-based price comparison tool that allows members to receive an estimate of their cost-sharing responsibility for a specific item or service from a specific provider or providers for 500 items and services.
5. Researchers Have Found Limitations to the Effectiveness of Payer Price Transparency Data
Researchers have found that payer price transparency data is not always accurate or complete and that it can be difficult for consumers to use. Lawmakers have also raised concerns about the accessibility of payer price transparency data and have called on CMS to take steps to make the data more user-friendly.
Overall, there has been progress in the area of payer price transparency, but there are still challenges that need to be addressed. CMS and lawmakers need to continue to work to ensure that consumers have access to accurate and complete price transparency data that is easy to use.
The updates to payer price transparency requirements in 2023 are a step in the right direction, but there is still more work to be done. CMS and lawmakers need to continue to work to ensure that consumers have access to accurate and complete price transparency data that is easy to use.
In addition to the above, here are some other limitations to payer price transparency data:
- The data may not include all providers or services.
- The data may not be up-to-date.
- The data may be difficult to understand.
Despite these limitations, payer price transparency data can be a valuable tool for consumers. By understanding the cost of care before they receive it, consumers can make more informed decisions about their health care.
