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Surprise Medical Bills: Should CMS Make Doctors Give Price Info Up Front?

Analysis  |  By Steven Porter  
   July 13, 2018

A price transparency RFI released by the agency this week asks for input on how CMS might develop consumer-friendly policy.

In a request for information announced Thursday, the Centers for Medicare & Medicaid Services asked whether providers and suppliers should be required to tell patients, in advance, how much a given healthcare service will cost out-of-pocket.

If the agency were to move forward with a price transparency requirement on physician practices, it could prove controversial. Many doctors say they themselves lack the training they would need to have effective conversations about how much the healthcare services they provide will ultimately cost patients.

But CMS has repeatedly indicated that it aims to get more pricing information to consumers one way or another.

"We are concerned that challenges continue to exist for patients due to insufficient price transparency," the agency wrote in its RFI, which is included in proposed revisions to the Physician Fee Schedule, Quality Payment Program, and other policies for 2019.

Some patients, for example, have received surprise bills for out-of-network doctors who provided services at in-network facilities, CMS said.

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"We also are concerned that, for providers and suppliers that maintain a list of standard charges, the charge data may not be helpful to patients for determining what they are likely to pay for a particular service or facility encounter," the agency added.

Earlier this year, as part of the proposed Inpatient Prospective Payment Systems (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) for 2019, CMS said it would begin requiring that hospitals not only make a list of their standard charges public but that it do so online in a machine-readable format with annual updates.

In order to determine what additional actions may be appropriate to connect consumers with accessible price information, the CMS price transparency RFI includes a variety of questions, including the following:

  • How should the phrase "standard charges" be defined in various provider and supplier settings?
  • Which information types would be most useful to beneficiaries, and how can providers and suppliers empower consumers to engage in price-conscious decision-making?
  • Should providers and suppliers have to tell patients how high their out-of-pocket costs are expected to be before providing a service?

The full list of questions, with details on how to submit a comment are available in the Federal Register. Comments are due September 10 by 5 p.m.

Steven Porter is an associate content manager and Strategy editor for HealthLeaders, a Simplify Compliance brand.

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