CMS Pricing Transparency Rule Summary
The finalized rule from the Centers for Medicare and Medicaid Services (CMS) establishes requirements for hospitals operating in the U.S. to establish, update, and make public a list of their standard charges for the items and services they provide. These actions are necessary to promote price transparency in healthcare and public access to standard hospital charges. By disclosing hospital standard charges, CMS believes the public (including patients, employers, clinicians, and other third parties) will have the information necessary to make more informed decisions about their care. CMS believes the impact of these policies will help increase market competition and ultimately drive down the cost of healthcare services, making them more affordable for all patients. This final rule is effective on January 1, 2021.
In accordance with the regulation, Eastern Plumas Health Care is required to make its list of standard charges for all items and services publicly available online in a machine-readable file and provide a consumer-friendly display of shoppable services.
The Price Estimator Tool provides a consumer-friendly display of standard charges for ‘shoppable’ services, including the 70 services mandated by CMS and other services commonly scheduled at our facility. Healthcare consumers can use this Price Estimator Tool to obtain an estimate of the amount they will be obligated to pay for a shoppable service. Please consider the following when using this Price Estimator Tool:
- Charges are current as of January 1 of the current calendar year.
- Price estimates are not a guarantee of third-party reimbursement or coverage and are subject to change at any time due to a variety of reasons, including complexity of case, severity of illness, additional services utilized, and more.
- Price estimates do not include physician charges or charges for services rendered by providers other than the hospital.
- Patients could also call the hospital directly to discuss estimates specific to amounts potentially owed (e.g., deductibles, copayments, and coinsurance balances).