MRF & Provider Pricing Transparency: AArete’s Innovative Approach to CMS Regulatory Compliance

Regulatory bodies are increasingly focused on policies aimed at enhancing cost-of-care transparency and empowering policyholders to examine comparable service costs from group and individual networks. While the objective of these efforts is to provide price comparisons for consumers, these extensive policies can create friction for providers with massive numbers of covered items and services or irregularly documented billable procedures. This friction carries over to payers who now must supply impute rates for specified professional services based on plan information, often resulting in gaps between hospital-provided rate configuration and payer data.