The Laws of Price Transparency: What Patients & Providers Need to Know

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As healthcare continues to become a more consumer-driven industry, price transparency has become one of the most important elements for consumers navigating the patient financial journey. Improving clarity and accessibility surrounding healthcare costs allows consumers to make more informed decisions and engage in the billing process. New legislation rolled out over the last two years calls on insurers and healthcare providers to disclose the costs of each item and service they provide.

The No Surprises Act, which took effect in January 2022, is a law that prohibits out-of-network medical billing for services received at in-network facilities. The Hospital Price Transparency Rule requires hospitals to post pricing information online, in a format that can be easily understood, to assist consumers in the decision-making process. By understanding and following these laws, providers can improve their rates of collections and patient satisfaction scores, while patients can feel more secure and competent throughout the payment process.

No Surprises Act

The No Surprises Act was enacted to protect people covered under group and individual healthcare plans from surprise medical bills and applies to most emergency and non-emergency services. The NSA gives patients certain legal protections around healthcare costs and billing practices. With improved transparency and billing protocols, healthcare consumers no longer have to worry about receiving an unexpected medical bill. 

When properly enforced, the NSA works to improve the patient financial experience; however, nearly half of consumers are not aware of the policy. 49% of consumers haven't heard of the NSA and those that have don't understand it. Keeping consumers engaged and empowered throughout their financial journey is critical for collections and patient satisfaction. In order for consumers to understand their rights and protections, policy makers and healthcare providers must ameliorate patient education and communication. 

Hospital Price Transparency Rule

The Hospital Price Transparency Rule aims to make price transparency more accessible to consumers by making hospital standard charges public, essentially making it easier for consumers to shop around for services and providers based on cost. Because patients are the primary payers, health systems must place an increased emphasis on value-based care. 73% of US consumers review and costs before choosing where and if they will pursue medical care, which demonstrates the how critical providing clear pricing information is for healthcare organizations struggling to engage new and existing patients. 

Despite this legislation, consumers continue to struggle to find and understand pricing information while searching for a provider. As of September 2021, fewer than six percent of hospitals have disclosed prices as requited by the Hospital Price Transparency Rule. 77% of people say it's “important” to “very important” to understand costs prior to receiving care, and 81% reported not being able to find readily available pricing information when researching costs. 

The Costs of Noncompliance

With the billing process being a major factor in patient satisfaction, health systems that fail to comply with these policies face losing patients and therefore, losing revenue. Ensuring compliance under the NSA begins with defining an internal strategy and message. Only 16% of health systems are compliant with price transparency laws, leading to a disconnect between health systems, insurers, and consumers that results in billing infractions and patient confusion.

The No Surprises Act requires hospitals and health systems to provide out-of-network and self-pay patients with an itemized cost estimate before providing treatment, including specific time frames. A "good faith" estimate includes outlining expected costs for primary service as well as the cost of additional services throughout the point-of-care experience. Beyond just numbers and figures, hospitals must be willing to give a comprehensive overview of what a patient is expected to pay. Ensuring a patient understands their estimate helps to build trust, boost likelihood of payment, and reduce call center activity. 

Because consumers are the primary decision-makers throughout the care journey, healthcare providers must adopt a patient-centered approach to meet patient and federal demands of price transparency. The hospital price transparency rule calls for increased collaboration between insurers, providers, and policy makers to achieve and maintain compliance. Rather than placing the burden on consumers, payers and health systems must work together to provide straightforward information surrounding costs and billing processes. 

Price transparency and medical billing can now be streamlined with digital solutions such as healthcare financing plans. While it is not a requirement under the NSA or hospital price transparency rule, payment plans help out-of-network and self-pay patients manage their medical costs by allowing them to spread out payments over time. 56% of respondents  in a recent study reported payment plans are very or extremely desirable. Utilizing a third party patient financing program also helps to optimize cash flow, automate the billing process, and decrease the likelihood of a patient receiving a surprise medical bill. Most financing platforms can be seamless integrated into a hospital's system, resulting in lower operating costs and reduced staff burden. 

75% of patients say that understanding their out-of-pocket costs improves their ability to pay for healthcare. With the rise of high deductible healthcare plans and climbing out-of-pocket costs, consumers rely on price transparency to help them navigate the complex payment process. If hospitals and health systems fail to comply with rules and regulations surrounding cost transparency and billing processes, they will quite literally pay the price, whether it be fines or lost patient receivables. Providers must continue to work together with policy makers, insurers, and their patients in order to become compliant and to maximize the patient experience. 

Partnering with a third-party financing program such as BridgeMed allows providers to digitize patient collections, improve patient engagement, increase patient volume, and improve the overall patient experience to boost patient loyalty. To learn more about the benefits of BridgeMed, contact us at info@mybridgemed.com, or visit our website, www.mybridgemed.com


 

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