The Centers for Medicare and Medicaid Services (CMS) recently launched its price
transparency website. The
Transparency in Coverage Final Rules require health plans and issuers to disclose in-network provider negotiated rates, historical out-of-network allowed amounts, and drug pricing information through three machine-readable files posted on an internet website, thereby allowing the public to have access to health coverage information to better understand health care pricing. Pathology and clinical laboratory payment rate data will be included among the payment rate that health plans and issuers must report.
Beginning July 1, 2022, most group health plans and issuers of group or individual health insurance will begin posting pricing information for covered items and services. This pricing information can be used by third parties, such as researchers and app developers to help consumers better understand the costs associated with their health care. More requirements will go into effect starting on January 1, 2023, and January 1, 2024, which will provide additional access to pricing information and enhance consumers' ability to shop for the health care that best meet their needs. Providers and laboratories may find the information useful in negotiating payment rates.
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