Currently, there is a lack of medical billing price transparency throughout the U.S. healthcare industry. According to an article now published in USA Today, a study finds few hospitals are meeting new federal transparency requirements, yet only two have faced fines.
Starting January 1, 2021, price transparency rules require health systems to publicly post the costs of their items and services online. The prices must include standard charges for all items and services for all payers and health plans and a standard charges list or a price estimator tool for the 300 most common services.
“They’re not complying, and nobody’s accountable,” a patient rights advocate said. This patient’s rights advocate is Christine Cooper, CEO of aequum LLC.
Hospitals must say how much they charge for hundreds of procedures. Here’s why many don’t can be viewed here (requires subscription)
aequum is a first-of-its kind tech-driven company in the complex field of medical billing. Its services are designed to create a competitive advantage by protecting partners, clients and members/dependents against unreasonable and balance-billing medical charges. aequum represents consumers and employers seeking to challenge medical bills over charges they believe are unreasonable and provides a dedicated team of associates who coordinate administrative and advocacy services.
As CEO of aequum and co-managing member of Cleveland-based Koehler Fitzgerald LLC, Cooper has represented consumers who have attempted to obtain pricing before undergoing an operation or procedure, only to face much higher charges when bills arrive.
According to Cooper, when she represents consumers contesting such charges, hospitals or other providers often fight disclosing price lists, even when cases end up in court. She welcomes the federal law mandating hospitals turn over such data.
But like others, Cooper expects some hospitals will be slow to hand over such information. She also notes that pricing information alone does not speak to the quality of care a patient gets.
Cooper said even if CMS begins fining more hospitals, larger hospital systems may choose to not reveal pricing information and instead pay fines “that are not even putting a dent into their profitability.”
“So, there’s not a lot of incentive to get them to comply,” Cooper said.
As your partner, aequum is here to help lower costs, achieve savings and support your plan’s member experience and success in 2022 and beyond. Please contact us if you have any questions or need for support. For more information, visit https://aequumhealth.com.