Price Transparency
Patients need relevant information to understand the price of care and their financial responsibilities. IHA is committed to supporting hospitals in meeting price transparency requirements.
- Updates
- No Surprises Act
- Resources
- Laws
MLN Presentation on Hospital Price Transparency: Encoding Requirements in the Machine-Readable File
The Medicare Learning Network (MLN) hosted a December 9 webinar on encoding the January 1, 2025 requirements in the Machine-Readable File, as well as tips for implementation.
Updates to Hospital Price Transparency Requirements
An IHA memo outlines several modifications to the hospital price transparency rule that the Centers for Medicare & Medicaid Services finalized in the CY 2022 OPPS final rule.
CMS Begins Enforcing Hospital Price Transparency Rule
CMS is auditing acute care hospitals for compliance with the hospital price transparency rule, which took effect January 1, 2021.
CMS Begins Enforcing Hospital Price Transparency Rule
CMS is auditing acute care hospitals for compliance with the hospital price transparency rule, which took effect January 1, 2021.
CMS Price Transparency Requirements Effective Jan. 1, 2021
CMS issued final price transparency requirements for hospitals, requiring all hospitals to make public their negotiated rates in specific file formats on their websites
Health Plan Price Transparency Rule Finalized
On Oct. 29, the U.S. Department of Health and Human Services, the U.S. Department of Labor and the U.S. Department of the Treasury released the Transparency in Coverage final rule.
IHA Summary: CMS Final Hospital Price Transparency Requirements
On Nov. 15, the Centers for Medicare & Medicaid Services issued final price transparency requirements for hospitals, including making public their negotiated rates.
Increased Arbitration Fees Under No Surprises Act
On Dec. 23, CY 2023 administrative fees for the federal IDR process increased 600% compared to fees in CY 2022.
HHS Delays Enforcement of GFE Co-Provider Requirements
Pending future rulemaking, HHS delayed requirements to include co-provider and/or co-facility expected charges for uninsured or self-pay good faith estimates.
IHA Comments on No Surprises Act AEOB and GFE Requirements
IHA comments on future advanced explanation of benefits and good faith estimate requirements for insured individuals.
No Surprises Act: Updated QPA and IDR Requirements
IHA summarized new final rules updating qualifying payment amount (QPA) and federal independent dispute resolution (IDR) requirements.
Public Act 102-0901 State Surprise Billing Legislation
Public Act 102-0901/HB 4703, effective July 1, 2022, amends Illinois’ surprise billing law to better align with the Federal No Surprises Act. Certain provisions of law go into effect Jan. 1, 2023.
No Surprises Act: Overview of Enforcement Responsibilities
A summary of State and Federal enforcement responsibilities regarding Illinois provider, facility and payer requirements under the No Surprises Act.
April 2022 No Surprises Act Update
The Centers for Medicare & Medicaid Services recently posted several updates on the CMS Federal Independent Dispute Resolution portal and recent No Surprises Act guidance.
Surprise Billing Patient Notices and Disclosures Effective Jan. 1, 2022
This chart summarizes notices and disclosures providers must make available to patients under the No Surprises Act beginning Jan. 1, 2022.
Surprise Billing Policies Effective Jan. 1, 2022
An IHA summary outlines provisions of the No Surprises Act that go into effect on Jan. 1, 2022, including patient balance billing protections and public disclosure of patient rights.
IHA Comments on Surprise Billing Regulations, Part II
IHA urges delayed enforcement of surprise billing regulations, as well as revisions to the independent dispute resolution and good faith estimate processes.
Federal No Surprises Act Implementation
IHA shares concerns on the No Surprises Act, which outlined new patient protections from surprise medical bills and requirements for healthcare providers and health plans.
Detailed Summary: No Surprises Act, Implementing Regulations Part II
IHA summarizes the second regulation implementing the No Surprises Act, including details on required good faith estimates and dispute resolution processes.
IHA Comments on Surprise Billing Enforcement Proposed Rule
IHA again urges deferred enforcement of surprise billing regulations, as well as increased transparency on how payers calculate qualifying payment amounts.
IHA Comments on Surprise Billing Regulations
IHA urges delayed enforcement of surprise billing regulations, citing the need for additional guidance, clarification, and resources to realize the goals of the No Surprises Act.
IHA Comments on Surprise Billing Notice and Consent and Model Disclosure Documents
IHA urges HHS to use consistent language throughout these documents and to ensure these documents mirror the required content and guidelines described in the final rule.
IHA Summary of No Surprises Act, Implementing Regulations Part 1
IHA summarizes the first of several regulations implementing the No Surprises Act, including how this law interacts with the State’s surprise billing law.
Federal “No Surprises Act” Addresses Surprise Billing – IHA Summary
The No Surprises Act, found on page 1629, outlines new patient protections from surprise medical bills and new requirements for healthcare providers and plans. See IHA's summary.
IHA Webinar: Hospital Price Transparency Requirements (11/15/22)
- Slides (password required)
- Frequently Asked Questions (password required)
IHA Webinar: No Surprises Act: Hospital Requirements (11/15/21)
- Recording (password: dVvhPxw6)
- Slides
- Questions and Answers
IHA Webinar: Ensuring Compliance with the Price Transparency Final Rule (9/15/20)
- Recording (password: PsJfsM9b)
- Slides
- Questions and Answers
IHA Webinar: Price Transparency Final Rule Compliance: Three Vendor Options (11/4/20)
- Memo (10/23/20)
Talking Points on Health Plan Transparency in Coverage Rule – July 2022
Talking Points on Final Price Transparency Rule – January 1, 2021
IHA Infographic (12/22/20)
Average Charges for Illinois Hospitals
- The Illinois Department of Public Health collects inpatient and outpatient charge information from hospitals. Hospital-specific average charges for more than 50 major diagnoses are available on the Hospital Report Card and Consumer Guide to Health Care website.
Healthcare Financial Management Association Resources
- Understanding Healthcare Prices: A Consumer Guide
- Avoiding Surprises in Your Medical Bills: A Guide for Consumers
American Hospital Association Resources
AHA Good Faith Estimate Infographic
- See an infographic created by the American Hospital Association (AHA), which assists providers with good faith estimate (GFE) requirements under the No Surprises Act. When must a provider give a good faith estimate for a scheduled service?
IRS Section 501(r) Regulation
An IRS final rule on December 31, 2014 adds requirements for hospitals to maintain exemption from federal income tax under Section 501(c)(3).
The Hospital Uninsured Patient Discount Act
The Hospital Uninsured Patient Discount Act requires hospitals to provide free and discounted care to eligible uninsured patients.
Fair Patient Billing Act
Per The Fair Patient Billing Act, hospitals must notify patients about the availability of financial assistance and comply with specific requirements regarding billing and collections.