Activating Transparency in Health Care Pricing

The Centers for Medicare & Medicaid Services (CMS) have taken up the campaign for price transparency over the past few years. The need for this is obvious and pressing. Unlike any other industry, health care institutions have historically been totally free to charge what they want and not even tell you in advance. Most of us have had lived the horror movie that follows a hospital stay, receiving a bill in the mail…and then another bill…and another… Hospitals have trouble predicting how much a procedure will cost for many reasons. They have a welter of agreements with different insurance companies and can’t pull together the information about coverage, deductibles, and copays that determines the ultimate out-of-pocket expenses for a patient. But CMS has been forcing providers and insurers to do so. Its Transparency in Coverage Final Rule went into effect on January 1, 2023. I talked recently with Marcus Dorstel, VP of Operations at Turquoise Health, about what the health care industry has done to expose prices. Figure 1 shows a sample report from Turquoise. *Figure 1: A report from Turquoise Health combines publicly available data to show data in an easy-to-read chart. In this chart concerning a cardiac MRI, it is easy to see enormous differences between some major hospitals. Turquoise Health has recently released a Good Faith Estimates service to help providers comply with the No Surprises Act. The service generates an estimate with the required p...
Source: EMR and HIPAA - Category: Information Technology Authors: Tags: Administration Analytics/Big Data Health IT Company Healthcare IT Revenue Cycle Management CMS Costs Healthcare Cost Transparency Healthcare Price Transparency Healthcare Prices Healthcare Pricing Marcus Dorstel Turquoise Health Source Type: blogs