Senators accuse payers of evading price transparency rules

Two senators are asking CMS to address loopholes in its price transparency rule for payers that they say have allowed the industry to "evade accountability."

"We are concerned that remaining technical loopholes have resulted in insurance companies publishing data that does not align with the intent of the CMS rule," Democratic Sen. Maggie Hassan and Republican Sen. Mike Braun wrote March 6.

Since July 1, payers have been required by CMS to disclose in-network provider rates for covered items and services, out-of-network allowed amounts and billed charges for all covered items and services.

The lawmakers 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." Because of those challenges, it's difficult to compare health plans and researchers and employers have struggled to use the data to drive lower costs.

According to San Diego-based transparency data startup Turquoise Health, it would take 76,104 decades to count up all the data available in machine-readable files.

"Trying to locate a single provider in the [transparency in coverage] files is akin to trying to find a single word in a very large dictionary that isn’t in alphabetical order," a January report from Georgetown University said.

"Experts have highlighted potential solutions, urging CMS to limit file sizes, create a standardized reporting template, reduce the frequency of reporting, and require a clear organizational system and standardized labeling," the senators wrote.

The letter also urges CMS to conduct random audits of health plan data to ensure compliance and quality.

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