Is your Healthcare Business prepared for the Price Transparency rule initiated to take effect in January 2022? The Consolidated Appropriations Act, 2021, is over 5,000 pages of legislation where price transparency rules are outlined, https://rules.house.gov/sites/democrats.rules.house.gov/files/BILLS-116HR133SA-RCP-116-68.pdf .

Beginning January 1, 2022, the Act requires Healthcare Providers to send Insurance Companies a good faith estimate of the cost for scheduled services and correlating CPT and diagnosis. The health plan is responsible to provide its members an Advanced Explanation of Benefits prior to scheduled services or anytime a patient requests this information. Healthcare Providers will be responsible to provide the same pricing information to any uninsured patients directly.  Regulations to the Act will be implemented by the Biden Administration.

Within the ruling, Healthcare Providers will be required to meet stringent timelines in relaying information to Insurance Companies. Providers will be required to routinely update insurance companies about their contact information and Providers who do not respond are suggested to be removed from the Insurance Company Network. Insurance companies will be required to make contracted pricing available for members so they can shop around for the most affordable healthcare services as well as assist members with locating an in-network provider where providers are found to be out-of-network.

Will your business be ready with an action plan for price transparency compliance in 2022?  There is no better time than now, to align your business with a billing company that stays on top of these matters and is ready to act and assist with necessary processes once regulations are set forth.