Making dollars & sense from Transparency in Coverage MRFs

In effort to increase healthcare transparency and empower consumers to make informed decisions, the Transparency in Coverage (TiC) rule was finalized in 2020 by the Depts of Health & Human Services, Labor, and the Treasury, requiring health plans to disclose negotiated prices for medical services, releasing Machine Readable Files (MRFs) for payments by procedure and provider beginning 7/1/22.

Workers’ Comp Provider Networks Need to Consider Social Determinants of Health

Traditional methods for measuring physician quality in workers’ comp have used quality measures based on adverse events: mortality rates, hospital readmissions and, in terms of Workers Comp, delayed return to work. As such, the process for selecting WC Network Physicians, may unintentionally overlook providers who do a better job of treating injured workers impacted by Social Determinants of Health (SDOH). Why? Because injured workers with SDOH factors such as restricted access to care, low income or education, lack of transportation and housing are the workers most likely to experience adverse health outcomes. Providers treating that group are measured poorly – not due to the quality of their medical care, but because of adverse events coming from SDOH factors totally out of their control.

Transparency in Coverage Raw Data Files Can Ensure Employer Health Plans Are Paying Fair Prices

Self-insured employers have a new tool to ensure they are paying fair prices for medical services. The Consolidated Appropriations Act, 2021 (CAA) established protections for consumers related to surprise billing and transparency in health care. It created a unique opportunity by establishing the Transparency in Coverage (TiC) requirements, making available all negotiated prices from every healthcare payer to every medical provider for every service in the U.S., beginning in the latter half of 2022, updated monthly. These rules provided unprecedented access to proprietary price information.

Telehealth on upward trajectory – Are you ready?

Many research and peer reviewed studies show that high-performing doctors produce better outcomes and cost less. Integrating evidence-based data of doctors’ practice experience like PRS into virtual health delivery platforms or health insurer’s provider network management system makes it easy for patients and professionals to find and access the best provider for their needs when and where they need the most, and at a more affordable cost.

Raising the Bar for Healthcare Providers

There is more to be gained by the release of Denniston Data’s Provider Ranking System, than the ability of users to find the most high-performing physicians…On a higher level, the very existence of an objective, transparent and annually updated ranking tool like PRS, serves a greater good.