Why Transparency Is No Longer Optional In Medical Billing

By Terry Rowinski, president & CEO, Health Payment Systems, Inc.

Terry Rowinski

Almost a year into the COVID-19 pandemic, the stress surrounding the rising number of cases and the ensuing economic recession reminds high. Nearly half a million Americans have been hospitalized due to coronavirus, putting untold stress on patients, their families and hospital staff. Healthcare and health insurance costs are likely to rise after an unprecedented year, while millions struggle to meet their basic needs. 

On top of that, surprise medical billing can quickly spiral into large amounts of debt and even bankruptcy. Routine tests alone can result in thousands of dollars in uncovered charges; some hospitalized patients have received bills upward of $400,000. While the situation absolutely harms patients, it also negatively impacts health providers, insurers and the industry at large. 

Just as we’ve reevaluated the way we conduct nearly every aspect of daily life, we’ve also had to take a hard look at whether our healthcare systems are actually working. In order to make informed decisions about their physical and financial health, consumers need greater transparency throughout the healthcare experience. 

After years of mounting demand for a better consumer experience in healthcare, we’ve reached a tipping point. Transparency is no longer optional. 

Patients need to choose providers based on quality and cost

Consumers have long been frustrated with the status quo because it doesn’t provide them with a source of truth about healthcare costs and healthcare quality. It’s baffling that healthcare is the only consumer experience that doesn’t encourage shopping for the best option at the best price. We have a suite of easily available tools to help us shop for most items, evaluate their quality and compare price. Why isn’t our healthcare—which is much more important than the latest gadget—the same?

For example, even when patients know to search for an in-network provider, they struggle to select the right one. Many insurance carriers have some aspect of price or force ranking of providers on the ‘Find a Provider’ section of their website—but these aren’t exactly intuitive user experiences (perhaps by design).


Consumers need as much information about a provider as possible to make an informed decision. They need data on which providers will be the best fit for their care. Yes, that includes price transparency, but human interaction is also crucial to a good doctor-patient relationship. Having the ability to search for an in-network provider that is accepting patients, affordably priced and high quality is huge for empowering consumers in their healthcare journey. 

COVID-19 has forced the rapid adoption of technology

Virtually every industry has learned to adopt digital solutions to meet the social distancing requirements necessary to combat COVID-19. While healthcare had been slow to digitize long before the pandemic, it was immediately evident just how far behind the industry was when healthcare providers couldn’t provide safe digital care options. 

While much of the conversation has been around technological solutions like telehealth and remote patient monitoring, technology can also provide us with ways to improve the patient’s full experience, not just the treatment. 

For example, secure, private communications can extend beyond telehealth to include easy ways to access administrative staff to quickly and easily ask questions. Offering self-service portals with a positive user experience will make it easier to perform simple tasks like accessing patient records, viewing EOBs and paying bills

After nearly a year of adapting to a remote world—from food delivery to mobile banking—patients will expect to be able to access the information they need from providers quickly and easily. 

Transparency is increasingly the law

Finally, transparency is no longer optional because transparency is increasingly part of the law. The Coronavirus Aid, Relief, and Economic Security (CARES) Act requires providers of diagnostic tests to make the cash price of a COVID-19 test publicly available on their website. 

In October, the Centers for Medicare & Medicaid Services (CMS) issued a final rule on healthcare price transparency. The rule is designed to ensure that consumers know how much their healthcare costs before treatment, allowing them to make better-informed decisions. Over the next few years, health plan providers will be required to make available on their websites pricing information for procedures, drugs, medical equipment and other service items. They will also need to include information on negotiated rates and historical pricing. 

Before then, hospitals will begin implementing a 2019 hospital price transparency rule that  requires them to provide clear and accessible pricing information online about their items and services. On January 1, 2021, hospitals will need to provide both a comprehensive machine-readable file with all items and services and a display of shoppable services in a consumer-friendly format.

The future is transparent

While we may not be able to predict the future, we do know it lies in transparency. Getting ahead of the moving towards greater transparency will not only help you with future compliance, but more importantly will improve the patient experience. 

One comment on “Why Transparency Is No Longer Optional In Medical Billing”

This was an amazing blog. Written very well as well in an easy-to-understand way. Totally agree with you on the transparency point here. Not only in medical billing but in other many fields as well.

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