Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

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Mass. Healthcare Payment Transparency Law Takes Effect

By Ryan Mcaskill

- On October 1, a new law officially took effect in Massachusetts that adds a new level of medical billing transparency. Now, anyone with private health insurance in the state can log on to their provider’s website and find the price of everything from an office visit to an MRI to a Cesarean section. Essentially, all pricing has been made public.

Passed in 2012, Chapter 224 of the Acts of 2012 is called “An Act Improving the Quality of Health Care and Reducing Costs Through Increased Transparency, Efficiency and Innovation.” It builds on two previous laws enacted in 2008 and 2010 that expanded data transparency and reporting on cost trends and drivers. It also aims to control premium growth in the merged individual and small group health insurance market.

The law features several provisions to earlier laws and new directives to help tame health care costs aside from price transparency. They include:

  • New commissions and agencies to monitor and enforce benchmark for health care cost growth
  • Wide adoption of alternative payment methodologies by public and private payers
  • A focus on wellness and prevention, through public investments and adoption of programs
  • Expansion of primary care workforce
  • Focus on health resource planning
  • Medical malpractice reforms
  • Financing and otherwise supporting the expansion of EHR and the state health information exchange

There are some caveats about the information that is available. The prices are not standard and will vary from one provider to the next, as will the actual procedures and services listed. The posted prices do not always include all charges like the cost of reading a test and the posted prices can change quickly as some have shifted in the matter of days. Quality of care information is also limited as there is little to no information about where one can get better care or prices. Finally, a majority of the information available is for outpatient care and not inpatient services like surgery or illness that requires a stay overnight in the hospital.

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  • While it seems like the new tools are lacking, that is only because they are new. Establishing real-time pricing will take time to perfect.

    “These tools are not perfect, but they are unlike anything else in the country,” a Kaiser Health News article reads. “While a few states are moving toward more health care price transparency, none have gone as far as Massachusetts to make the information accessible to consumers.”

    Tufts Health Plan Director of Commercial Product Strategy Athelstan Bellerand added in the article that these tools are a step in the right direction and will help patients become more informed consumers of health care.

    As this blog covered last week, more hospitals are starting to implement upfront medical billing. One of the reasons for this is to improve transparency in the cost model, so patients know what they are spending money on up front. This law plays into that idea, ensuring both parties are on the same page from the beginning and giving consumers more control of their care.

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