Price Transparency Requirements – Insurers
There is a new deadline that just passed for insurers – beginning on July 1, 2022, insurers are now required to provide price transparency publicly via a machine-readable format file that shows fees that have been negotiated. Watch the video to learn more!
Transcript:
There have been a lot of discussions surrounding price transparency, hospital postings of fees, and other things. And for a change, this is a regulation that won’t directly impact anything for you, as a chiropractic physician in private practice unless you work for a hospital. However, there is a new deadline that just passed for insurers. And so beginning on July 1, 2022, insurers are required to provide publicly a machine-readable format file that has fees related to negotiated amount. So your fee schedule, for example, as a chiropractic physician, or fee schedules that have been negotiated with hospital systems, or medical groups, or whatever the case might be, and their standard fees for general networks are all now available through what’s called a machine-readable format, which means that it will be able to be accessed, you know, but it’s going to be fairly complicated, as referenced by group number and different coding protocols and things along those lines.
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The reason why we’re bringing this to your attention, because the deadline one was July 1, there’s no action for you to take as a small provider, but instead, you very well may get questions or comments from patients. So we want you to be aware. So the way that the whole price transparency is going to work for insurers comes in three phases. This is the first big phase, this machine-readable format file has to be published, and it has to be updated at least once a month. And so that’s out there, the next step actually begins January 1 of 2023, where they have to give a tool to the patients to be able to search these 500 specific different services or items, that have to be searchable on a variety of different formats for the patients to be able to determine what those rates are, what their cost is going to be.
Beginning on January 1, 2024, the insurers are required to put out there, the entire suite of services and items that are available to patients and what their coverage amount is what the negotiated rates are, depending on the provider, depending on the service, depending on their plan, all of those things are going to be factored in, and it has to be online. So right now it’s a machine-readable format. The common everyday person probably isn’t going to be able to utilize that. However, very well, it can be apps and will be apps that utilize those machine-readable formats, to put it into more common language for patients. So you may get questions, we want you to be aware when those questions come up. This is how they obtained the records. This is how they obtained the information was in these machine-readable formats.
As more information develops in regards to the price transparency for insurers and how that directly impacts you as a provider or indirectly impacts you as a provider will let you know but the good news is this is one of those regulations that is on the requirements are on a different entity and not chiropractic physicians, but may trickle down into your practice when you get questions. Again, machine-readable formats July 1 500 services and an online searchable format for patients beginning January 1 of 2023, and then everything not just 500 but everything beginning January 1 of 2024. Hopefully, this information helps you out today and next week.
