On Friday, July 1, 2022, the first phase of the Transparency in Coverage Final Rule, issued by the Centers for Medicare and Medicaid Services (CMS), went into effect. This phase requires employers and health insurers to publish their negotiated rates with hospitals and the amounts paid to out-of-network providers. Phase two, to be implemented in January 2023, will require insurers to list cost estimates for nearly 500 common items and services, such as x-rays and colonoscopies Phase 3 which will be enacted by January 2024, will require insurers to post cost estimates for all items and covered services. Insurers who fail to comply with these reporting requirements could be subject to a $100 fine per day for each beneficiary affected by the violation.
The goal of this rule is to increase transparency within the healthcare system, to help enable enrollees and employers to make informed decisions regarding their health insurance. However, some experts worry that the sheer volume of information produced by insurance companies could be overwhelming for patients to sift through. Moreover, advocates have also expressed concern that insurers may not comply and are calling for the CMS to have an aggressive enforcement strategy. A similar rule applying to the hospital industry has been in effect since January 2021, yet a report by PatientRightsAdvocate.org shows only 14% of the 1,000 hospitals reviewed were compliant with transparency requirements. If implemented as planned and enforced, the Transparency in Coverage Final Rule could provide more information to employers and enrollees when negotiating rates with their insurance companies. Read more about the Transparency in Coverage Final Rule here.