Months After Taking Effect, Hospital and Insurer Transparency Compliance is Lacking

This summer, new hospital and insurer transparency rules took effect in the US that requires payers to disclose what they pay providers for items and services. However, despite this and a similar 2021 rule regarding hospital prices, few health systems have reported prices as required and even fewer out of compliance systems have seen penalties.

According to Maanasa Kona and Sabrina Corlette, “Even when hospitals have complied with the rules, experts have found the data to be ‘consistently inconsistent’ in terms of how data elements are defined and displayed, making it very difficult for third parties to make connections across hospitals and payers. Based on their experience with hospital transparency rules, CMS issued several pieces of technical guidance to insurers before the rules applicable to health plans went into effect. Insurers that fail to comply with health plan transparency rules will face fines of around $100 per violation, per day, per affected enrollee, which can quickly add up to far larger fines than those faced by hospitals. Initial reports suggest that most insurers have complied with the technical requirements of the rule, but the data files they have posted are largely inaccessible and indecipherable to anyone without access to a supercomputer.”

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(Source: Health Affairs, September 12^th, 2022)