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Volume 2  Issue 2

“Healthcare Price Transparency”


that. Healthcare price transparency ensures all patients will know the cost of care or medical supplies before receiving them. They can, then, decide if they want to proceed or go to another “dealership.”


The Centers for Medicare and Medicaid (CMS) instituted a rule effective January 1, 2021, that each hospital operating within the United States would be required to provide clear, accessible pricing information online about the items and services they provide. Not only are hospitals mandated to be transparent with their pricing, but CMS was very specific. Hospitals were mandated to provide the information as a comprehensive machine-readable file with all items and services listed and to display this list of shoppable services in a consumer-friendly format.


Hospitals are known to charge exorbitant prices using opaque charging practices that blind consumers to prices. Consumers are then blindsided with inflated bills they may never have agreed to had they known the price for their care upfront. Now that hospitals are required to share their discounted cash prices and negotiated insurance rates by health plan, patients are now armed with this information and can advocate for better pricing by surveying wide price gaps or variations for the same care, even at the same hospital, to avoid price gouging and access care at fair market rates. Vigorous price transparency can hold hospitals and other healthcare organizations accountable for egregious overcharging for procedures like $5,000 MRIs, $100,000 knee surgeries that may range anywhere from $250 to $18,000 at cash-based centers, respectively. 


It has been two years since hospitals were mandated to adhere to these requirements. To ensure hospitals comply with the new rule, CMS performs random audit checks and fines hospital a civil monetary penalty (CMP) for non-compliance. Interested in knowing how hospitals are stacking up against the price transparency rule? Of course, you do!


Here are enforcement actions taken against Northside Hospital Atlanta and Northside Hospital Cherokee for non-compliance.


Healthcare may be a medical necessity, but price gouging is not. Know your rights. Go to your hospital’s website and look for these files to ensure you are getting the best care at reasonable rates. If you cannot locate the files, ask.


Price transparency matters to be because I am you, and even though I work in the healthcare industry, I will always be on the side of “right.”


When you go shopping for a house, or a car, you probably do your research before you begin the process. If you are searching for a new home, you may look at the “comps” of other homes in the area that recently sold to determine what you’re getting for the money. Looking for a new car may require stopping at many different dealerships to negotiate a fair cost for the vehicle. So, you may pull the value of the car before going to the dealerships, so you are armed with information to net you a fair deal. Right?

Price transparency in healthcare is a lot like

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