Hospital Pricing Transparency Rules

The Center for Medicare and Medicaid Services (CMS) has released rules requiring hospitals to post standard charges online. Previous law required that hospitals make a list of standard charges uniform and public. The guidelines have been updated, effective January 1, 2019, to specify that hospitals are required to list these charges via the Internet in a machine readable format. Additionally, hospitals must update the list at least once annually and more often if necessary.

CMS released a statement saying, “CMS encourages hospitals to undertake efforts to engage in consumer friendly communication of their charges to help patients understand what their potential financial liability might be for services they obtain at the hospital, and to enable patients to compare charges for similar services across hospitals.” This mandate makes public the difference between hospital charge rates and reimbursement amounts.

The listed prices are based on the hospital’s standard pricing and are not reflective of your insurance network’s negotiated rates. In order to get a more accurate estimate of any procedure, ask your provider for the necessary medical codes and request a pricing summary from your insurer or contact Business Benefits for assistance.