The rule finalized by the Department of Health and Human Services (HHS), the Employee Benefits Security Administration and the IRS on Monday builds on an earlier requirement that hospitals publish their prices in a “machine-readable file” so patients can find and compare the cost of services beforehand.
Insurers and most employer-sponsored health plans currently post monthly files, listing in-network rates, out-of-network payments and drug prices.
But in practice, that information is presented in gargantuan raw data dumps that are cluttered and filled with prices for unrealistic services, like the price for a heart surgery done by a psychiatrist, or a baby delivery performed by a podiatrist.
“Simply put, you basically need a supercomputer to process the data, which has limited who can work with the data,” said Peter Nelson, who directs the Center for Consumer Information and Insurance Oversight (CCIIO) at the Centers for Medicare and Medicaid Services.
The new rules seek to make the data more standardized and usable.
It also requires insurers to report in-network rates as a dollar figure, instead of a percentage or some other estimate, though there are exceptions.
HHS Secretary Robert F. Kennedy Jr. said the new rules would reduce file sizes of pricing data by 70 percent.
“The results will be better information for the people who need it. Patients will be better able to compare what care costs before they receive it, and lawyers will be better able to judge whether the insurers that they hire are negotiating the best prices for their workers, and researchers will be able to identify price disparities and study where the market is failing and where the system is failing,” Kennedy said.
The administration said the rule changes will save plans about $174.5 million annually.
Read more at TheHill.com.
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