Transparency

New federal price transparency laws require hospitals and insurance carriers to provide healthcare cost information online, which includes posting machine-readable files with a variety of different rate information, as well as a consumer-friendly display of rate information for at least 300 shoppable services.  Click here for links to NC hospital and health system price transparency pages.

North Carolina’s Health Care Transparency Law and Regulation requires hospitals and ambulatory surgery centers to provide an annual data report that includes charges and payment for the top inpatient 100 DRG’s, the 20 most common outpatient surgical procedures and the 20 most common outpatient imaging procedures (as determined by Hospital Industry Data Institute). The next submission, due to HIDI on Jan. 15, 2023, is required to include 12 months of DRG and outpatient procedure data for the period ending Sept. 30, 2022 for all sites operated by the licensed hospital or ambulatory surgery center.

Guidance for preparing these reports can be found in the File User Guide, and by logging into Transparency Law/Rule section of NCHA’s website below. There you will also find updated tables for use in accurately reporting Medicare services (RCC Transparency Template).

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