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CMS finalizes 2020 price transparency rules for outpatient prospective payment system

CMS finalized a price transparency policy in its 2020 outpatient prospective payment system.

The policies would apply to all hospitals in the U.S., requiring them to publicly post standard charge information starting in January 2021.

The CMS policy applies to at least 300 "shoppable" services that can be scheduled by a consumer — 70 of the charges were selected by CMS, and 230 were selected by hospitals. CMS said the requirements are intended to give patients the ability to compare payer-specific negotiated charges across healthcare settings.

The policy requires hospitals to display the information on a website, accessible without charge. The information must include a description of the service, the payer-specific charges, negotiated cash prices and minimum and maximum negotiated charges. The information must be updated annually, with the date of the update clearly stated.

CMS also issued a proposed rule that would require employer-based group health plans and insurers offering group and individual coverage to share prices and cost-sharing information with patients. If finalized, the rule would make negotiated rates for in-network providers and allowed amounts for out-of-network providers public on a website.

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