On Jan. 1, 2022, a number of new transparency requirements that concern commercial health plans will begin to take effect related to the Transparency in Coverage (TIC) rule and the No Surprises Act (NSA). The broad objectives of these rules are to allow plan members to better compare service pricing across providers before receiving care and to avoid “surprise bills” not covered by their plan. Compliance and enforcement of the TIC rule and NSA will have a staggered rollout by provisions with recent and continual guidance and enforcement updates by the Centers for Medicare & Medicaid Services (CMS). Health plans must stay apprised of these provisions and updates to meet compliance dates for requirements that have been operationally challenging to implement.
Furthermore, with many hospitals and health systems having been criticized for not adhering with their earlier January 2021 implementation date, and with CMS increasing fines for providers that are still not in compliance, health plans should take note to ensure they are adhering to their health-plan-specific reporting obligations.
Listen to our informative, on-demand webinar to learn what health plans should be doing in order to comply with the price transparency rule. Key takeaways from the webinar include:
For more information on this topic, or to learn how Baker Tilly’s Value Architects™ can help, contact our team.