Will a New Rule Expose Too Much About the Cost of Care in Your UC Operation?

A new rule (effective July 1) from the Centers for Medicare & Medicaid Services now requires health insurance and self-insured employers to post the rates they’ve negotiated with providers. While that could mean unprecedented public access to what was previously eyes-only for insurance industry insiders, the catch is that data posted as *.json (JavaScript Object Notation) files can only be machine-read—essentially making the data inaccessible to all but academics and professionals. So, Alan Ayers, MBA, MAcc, president of Experity Networks and senior editor, practice management for JUCM explains, “until third parties start to harvest the data, it won’t bring any value to consumers.” He also notes, however, that the data may have value for C&C purposes for urgent care operators. As first reported jointly by NPR and Kaiser Health News, the new requirements expand on earlier regulation that mandated hospitals to posted negotiated rates publicly. Ostensibly, the report points out, the net result could be more informed pricing among healthcare providers—either in the form of lowering prices to become more competitive or raising prices if a given practice finds that it has been charging less than their peers.