There is plenty of payer price transparency data available online, and many companies have posted complete, accessible data, according to Turquoise Health's first-quarter price transparency report.
Though data is out there, researchers have found there are still limitations to its effectiveness, and lawmakers have raised concerns about its accessibility.
Here are five price transparency updates Becker's has reported in 2023.
- Payers have been required to post pricing information online for covered items and services since July 2022, but several limitations exist to providing the true cost of care to patients. Here are six limitations with payer price transparency data, according to Elevance Health researchers.
- In April, CMS proposed two new rules 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.
- Dozens of payers have posted accessible and complete price transparency data since requirements for payers to publish negotiated rates took effect, according to Turquoise Health. Here are the 48 payers that got perfect scores on price transparency from the price transparency software company.
- Two senators asked CMS to address loopholes in its price transparency rule for payers that they say have allowed the industry to "evade accountability." Democratic Sen. Maggie Hassan and Republican Sen. Mike Braun 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."
- 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.