Health insurance across the US has adopted their own languages, not only across the healthcare industry, but within each payor. If your staff is tasked with locating and reading payment policies you know how time-consuming and confusing it can be, not only to find the policies.

Most revenue cycle claims editing companies focus on Centers for Medicare and Medicaid (CMS), National Care Determinations (NCD), Local Care Determinations (LCD), and broad national standards. Those are great baselines for medical claim editing, but what moves claims editing from baseline into claims editing with accurate efficiency?

With a huge rise in the premiums of private health insurance policies and the co-pay, the cost of healthcare including maternity costs is continuously increasing causing a hefty price burden on the American consumers. One major factor that acts as a hindrance in curbing the cost of healthcare is an absence of price transparency.

Price transparency involves informing, preparing, and involving individuals about treatment costs before receiving them. It essentially improve healthcare standards and encourage individuals to get the right treatments without intentional or unintentional delays. In the United States, health spending was found to have increased by 2.7% in 2021 to $4.3 trillion.

The growth of health care cost-sharing in recent years has led to increased demand for price transparency. Federal government, State legislatures and corporate boardrooms have responded with various programs to make the costs of health care services more accessible.

CMS’s price transparency rule is to make healthcare costs transparent and allow patients to compare prices across hospitals to find facilities that offer the same service at a lower cost. But a recent survey conducted by Kaiser Family Foundation (KFF) identified that most of the adults are unaware of this rule.