BIP Fall 2024

Susan Rider, president elect, sees the association playing a pivotal role in advancing healthcare billing transparency. According to Rider, strategies include: 1. Advocacy for clearer legislation: “ By engaging with policymakers and pushing for regulations that require itemized, easy-to-understand bills, we can help ensure patients know exactly what they are paying for.” 2. Education and training: “ Providing resources and training on how to navigate and explain bills to clients will empower our members to better advocate for their clients. This can also include teaching members how to identify and contest erroneous charges.” NABIP’S PLANS 3. Collaboration with industry stakeholders: “ NABIP can form strategic alliances with healthcare providers, insurance companies and consumer advocacy groups to promote transparency and create industry-wide standards that prioritize the patient’s understanding and experience,” Rider says.

The Lower Costs, More Transparency Act (H.R. 5378) This act passed the House on Dec. 11, 2023. It im proves price transparency by empowering patients and employers to shop for healthcare by providing timely and accurate information about the cost of care, treatment and services. The law also requires hospitals, insurance companies, labs, imaging pro viders and ambulatory surgical centers to publicly list the prices they charge patients. Affordable and accessible medications are also a key part of this legislation, starting with requir ing health insurers and pharmacy benefit manag ers (PBMs) to disclose negotiated drug rebates and discounts. The law would lower out-of-pock et costs for seniors who receive medication at a hospital-owned outpatient facility, expand access to generic drugs and equip employer health plans with information to negotiate the best drug prices for employees. The PRICE Transparency Act (S. 3548) Pending in the Senate, this act would amend the Public Health Service Act to create hospital and insurer price transparency by imposing data-sharing standards. The law would require: ▶ pricing data standards, including all billing codes for services ▶ actual prices for 300 shoppable services, with all services by 2025 ▶ machine-readable files of all negotiated rates and cash prices between plans and providers, not estimates The law would also create new transparency standards and would: ▶ Expand price transparency requirements to clini cal diagnostic labs, imaging centers and ambula tory surgical centers ▶ Prevent preemption of state price transparency laws, except for ERISA group health plans ▶ Provide group health plans the right to access, audit and review claims encounter data ▶ Require attestation by executives that all prices are accurate and complete ▶ Codify the Transparency in Coverage (TIC) rule Facilities that don’t comply would be subject to higher maximum annual penalties of up to $10 mil lion (this includes specific minimum and maximum

38 bip magazine Fall 2024