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December 3, 2018

How you can try CMS' new Medicare price transparency tool

Daily Briefing

    CMS on Tuesday launched an online tool that allows users to compare Medicare payments and copayments for procedures performed in ambulatory surgical centers (ASCs) and hospital outpatient departments.

    CMS said the new tool is part of the agency's eMedicare initiative, which aims to provide Medicare beneficiaries with cost and quality information. The tool also was mandated under the 21st Century Cures Act.

    About the tool

    The online tool, called the Procedure Price Lookup, shows both the national average that Medicare pays ASCs and hospitals for certain procedures, as well as the national average copay a Medicare beneficiary without supplemental insurance would pay for the procedure.

    According to Modern Healthcare, patients who need certain types of surgery, such as knee surgery, can use Procedure Price Lookup to find estimates of out-of-pocket costs for procedures at ASCs and hospitals. Under federal law, Medicare maintains separate payment systems for different sites of care, which means the amount Medicare and patients pay can vary based on where care is provided.

    Verma says tool will help boost price transparency

    CMS Administrator Seema Verma said CMS' varying payment rates at different care locations "are a prime example of Medicare's misaligned financial incentives, under which providers can make more money if they see patients at one location as opposed to another." Verma continued, "Unfortunately, it would take an act of Congress to change the payment systems within Medicare that charge patients different prices for the same services based on the care setting, but in the meantime patients have the right to at least know what they will be charged" (Dickson, "Transformation Hub," Modern Healthcare, 11/27; Commins, HealthLeaders Media, 11/27; Roubein, "Pulse," Politico, 11/28; CMS release, 11/27).

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