Fact Sheet | Pricing

Health Plan Price Transparency in Coverage Proposed Rule Summary

Fact Sheet | Pricing

Health Plan Price Transparency in Coverage Proposed Rule Summary

On November 27, 2019, the Internal Revenue Service of the Department of the Treasury, the Department of Labor, and the Department of Health and Human Services published a proposed rule that would require group health plans and health insurance issuers in the individual and group markets to disclose, upon request, cost-sharing amounts, in-network provider negotiated rates, and out-of-network allowed amounts to a participant, beneficiary or enrollee. In addition, plans and issuers would be required to publicly disclose in-network provider negotiated rates and out-of-network allowed amounts.

Download the summary


Related Articles | Pricing

News | Coronavirus

HFMA recommended coronavirus resources

The coronavirus is affecting the healthcare industry in unprecedented ways, and HFMA wants to help you stay up to date on the latest news about the outbreak. Come back to this page regularly for coronavirus resources, selected specifically for healthcare finance professionals, including Medicare information on regulations and guidelines, COVID-19 test pricing, COVID-19 coding, telehealth billing FAQs and more.

Column | Consumerism

Price transparency as a guiding principle: directionally correct

HFMA President and CEO Joe Fifer offers a perspective on HFMA’s approach to price transparency vis-à-vis the upcoming CMS regulations on payment rate transparency.

How To | Pricing

How to develop a winning pricing strategy in the post-COVID-19 consumer market

Providers and health plans should prepare for federally imposed price transparency mandates imposed by developing comprehensive pricing strategies tailored to their specific market positions, financials and operational objectives.

Comment Letter | Payment, Reimbursement, and Managed Care

HFMA Comments on Measures to Ensure Safety Net Hospital Operational Sustainability

HFMA presents its comment letter to Congressional leaders on measures to ensure the operational sustainability of safety net hospitals.