As Clear As Day – Hospital Price Transparency Regulations

Hospital price transparency has been a hot topic for several years and continues to come up on the state and national level. While it’s a law that hospitals need to provide pricing information, there are really no penalties for noncompliance. However, some states are taking the initiative to make penalties a reality.

Making it Transparent

At the beginning of 2021, the Centers for Medicare & Medicaid Services (CMS) published their final rule that required hospitals operating in the United States to provide clear, accessible pricing information online about the items and services they provide in two ways:

• As a comprehensive machine-readable file with all items and services.
• In a display of shoppable services in a consumer-friendly format.

This information was intended to make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital.

A February 2023 blog from HealthAffairs said between 2021 and 2022 the number of hospitals in compliance went from 27 percent to 70 percent. While this is quite a big jump in compliance, CMS requires all hospitals be in compliance.

Currently there is no national penalty for not reaching compliance with hospital price transparency, but some states have taken steps to enforce this requirement. Below are three states that have legislation in place or moving forward and how they impact collections.

Colorado

Beginning on August 10 in 2022, HB22-1285 was signed into law by Governor Polis. The bill ensures Colorado hospitals are in compliance with federal hospital price transparency laws and prohibits hospitals from collecting debts from patients if they were not in compliance at the time of treatment. The way it works is by allowing patients who believe a hospital was not in compliance with federal laws to file a lawsuit to have their debt forgiven and other fees covered. It also requires hospitals to post standard prices on a public website to increase hospital price transparency. 

It should be noted that nothing in the act prohibits a hospital from billing a patient or health insurer for items or services provided to the patient or requires a hospital to refund a payment made to the hospital for items or services provided.

Oklahoma

According to a recent report, only 10 percent of Oklahoma hospitals are in full compliance with the federal law. In February 2023, HB 1890 was introduced to amend two laws, 63 O.S. 2021, Section 1-725.3 and 60 O.S 2021, Section 1-725-4. They both deal with hospital price transparency, creating penalties for noncompliance and the allocation of those penalties, and it would provide an effective date for this to happen.

Currently HB 1890 has passed the Public Health Committee.

Ohio

In Ohio, HB49 is much like its Oklahoma counterpart. It codifies the federal requirements that hospitals are required to post prices for consumers. If hospitals are found to be in noncompliance with the new law, it would prohibit them from referring, assigning or selling medical debt to a debt collector. They would also be unable to use the state court system to obtain a judgement for an outstanding medical debt and they would not be allowed to file negative credit reports against patients.

Conclusion

As more attention is brought to hospital price transparency the more state legislatures will start taking notice and proposing new laws. The best way to overcome this is to make sure your hospital is in full compliance with the federal law. Contact us today to see how we can help and keep your Early Out and Bad Debt collections in check.