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.
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 is auditing acute care hospitals for compliance with the hospital price transparency rule, which took effect January 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
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.
On Nov. 15, the Centers for Medicare & Medicaid Services issued final price transparency requirements for hospitals, including making public their negotiated rates.
On Dec. 23, CY 2023 administrative fees for the federal IDR process increased 600% compared to fees in CY 2022.
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 future advanced explanation of benefits and good faith estimate requirements for insured individuals.
IHA summarized new final rules updating qualifying payment amount (QPA) and federal independent dispute resolution (IDR) requirements.
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.
A summary of State and Federal enforcement responsibilities regarding Illinois provider, facility and payer requirements under the No Surprises Act.
The Centers for Medicare & Medicaid Services recently posted several updates on the CMS Federal Independent Dispute Resolution portal and recent No Surprises Act guidance.
This chart summarizes notices and disclosures providers must make available to patients under the No Surprises Act beginning 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 urges delayed enforcement of surprise billing regulations, as well as revisions to the independent dispute resolution and good faith estimate processes.
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.
IHA summarizes the second regulation implementing the No Surprises Act, including details on required good faith estimates and dispute resolution processes.
IHA again urges deferred enforcement of surprise billing regulations, as well as increased transparency on how payers calculate qualifying payment amounts.
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 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 summarizes the first of several regulations implementing the No Surprises Act, including how this law interacts with the State’s surprise billing law.
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)
IHA Webinar: No Surprises Act: Hospital Requirements (11/15/21)
IHA Webinar: Ensuring Compliance with the Price Transparency Final Rule (9/15/20)
IHA Webinar: Price Transparency Final Rule Compliance: Three Vendor Options (11/4/20)
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
Healthcare Financial Management Association Resources
American Hospital Association Resources
AHA Good Faith Estimate Infographic
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 requires hospitals to provide free and discounted care to eligible uninsured patients.
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.