Transparent piggy bank

When attempting to use transparency data to benchmark facility (hospital and ambulatory surgery center) pricing, Plato’s Allegory of the Cave draws a stark parallel to how the Payer Price Transparency files have deviated from their original intent. In Plato’s allegory, prisoners chained in a cave see only the shadows on the wall, mistaking them for reality. These distorted shadows are a far cry from the objects casting them.

The facility rates in Payer Transparency in Coverage files (or TIC files) often do not reflect the rates that the original payer-provider contracts would produce, and therefore are only part of the answer to hospital price research.

With the TIC Files, the payer-provider contracts are the “real objects” outside the cave: straightforward, foundational, and direct in indicating how rates should be calculated. While these contracts can contain a simple translatable price list, they often also contain complex formulas that require the actual charges and coding pattern to determine the price.

Complete your profile to continue reading and get FREE access to BenefitsPRO.com, part of your ALM digital membership.

Your access to unlimited BenefitsPRO.com content isn’t changing.
Once you are an ALM digital member, you’ll receive:

  • Critical BenefitsPRO.com information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and BenefitsPRO.com events.
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com

Already have an account?


NOT FOR REPRINT

© 2023 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.

 

BenefitsPRO

Join BenefitsPRO

Don’t miss crucial news and insights you need to navigate the shifting employee benefits industry. Join BenefitsPRO.com now!

  • Unlimited access to BenefitsPRO.com - your roadmap to thriving in a disrupted environment
  • Access to other award-winning ALM websites including ThinkAdvisor.com and Law.com
  • Exclusive discounts on BenefitsPRO.com and ALM events.

Already have an account? Sign In Now
Join BenefitsPRO

Copyright © 2023 ALM Global, LLC. All Rights Reserved.