• Help Center
  • Future Actuaries
    What is an Actuary?
    Why Become an Actuary?
    How to Become an Actuary?
    Affiliate Membership
    Access Affiliate Benefits
    Candidate Events
  • Education & Exams
    Designations & Credentials
    Exams & Requirements
    University Resources
    Educational Pathways Associate of the Society of Actuaries (ASA) Fellow of the Society of Actuaries (FSA) Chartered Enterprise Risk Analyst (CERA) Micro-Credentials
    Exam Registration Exam Results New ASAs, CERAs and FSAs Past Exams and Solutions Validation by Educational Experience (VEE) General Information CIA Candidate
    Universities & Colleges with Actuarial Programs (UCAP) CAE: Centers of Actuarial Excellence University-Earned Credit (UEC) Program Hickman Scholars Program Academic Benefits
  • Professional Development
    Major Meetings
    Professional Development Edge
    PD Tools & Resources
    Asia-Pacific Symposium China Symposium Health Meeting ImpACT Conference Middle East, Africa, S. Asia Symposium ReFocus Conference ValAct Meeting
  • Research Institute
    Research By Topic
    Experience Studies Pro
    Tables, Calculators & Modeling Tools
    Research Opportunities
    Actuarial Research Clearing House (ARCH)
    NAAJ Practical Application Essays
    About the SOA Research Institute
    Aging & Retirement Artificial Intelligence Catastrophe and Climate COVID-19 Disability Diversity Equity & Inclusion Finance & Investment General Insurance Health Care Cost Trends Innovation & Technology International Life & Annuities Long-Term Care Mortality & Longevity Predictive Analytics & Modeling Risk Management U.S. Population Valuation/Illustrations
    Sponsorships Proposal Requests Data Requests Calls for Papers Funding & Grants Competitions & Awards Academic & Student Research
    Strategic Research Programs Trending Research Recently Published Research Volunteer with the SOA Research Institute
  • Sections & Communities
    Explore Evolution to Communities
    Sections
    Emerging Topics Community
    Evolution to Communities Community Governance Communities FAQs
    About SOA Sections Actuary of the Future Education & Research Entrepreneurial & Innovation Financial Reporting Health International Investment Joint Risk Management Leadership & Development Long Term Care Insurance Marketing & Distribution Modeling Predictive Analytics & Futurism Product Development Reinsurance Retirement Smaller Insurance Company Social Insurance & Public Finance Taxation Technology
  • Tools & Resources
    Connections
    Actuarial Practice
    Other
    Publications
    SOA Explorer SOA Engage SOA Cares Actuarial Clubs Actuarial Directory Listservs Employers
    Mortality and Other Rate Tables (MORT) Relative Risk Tool Annuity Factor Calculator
    Longevity Illustrators Actuaries Climate Index Predictive Analytics MentorLink
    The Actuary Magazine North American Actuarial Journal (NAAJ) SOA E-Newsletters Actuarial Books Writing Opportunities With the SOA
  • About SOA
    About SOA
    Governance
    Membership
    Newsroom
    Topics in the News
    Volunteer Program
    Contact SOA
    Job Opportunities
    Legal Center
    Strategic Plan Diversity, Equity & Inclusion Societal Purpose
    Strengthening Our Board Board of Directors Elections Staff Leader Disciplinary Determinations
    Dues for Membership CPD Requirement Join an SOA Section or the Emerging Topics Community Read Member Obituaries
    SOA News SOA Board of Directors Communications
    Predictive Analytics InsurTech
    Volunteer Opportunities SOA Awards
    Customer Service Center Department Directory
    Job Center Careers at SOA
Log in / My SOA
search
  • Help Center
  • Future Actuaries
    • What is an Actuary?
    • Why Become an Actuary?
    • How to Become an Actuary?
    • Affiliate Membership
    • Access Affiliate Benefits
    • Candidate Events
  • Education & Exams
    • Designations & Credentials
      Educational Pathways Associate of the Society of Actuaries (ASA) Fellow of the Society of Actuaries (FSA) Chartered Enterprise Risk Analyst (CERA) Micro-Credentials
    • Exams & Requirements
      Exam Registration Exam Results New ASAs, CERAs and FSAs Past Exams and Solutions Validation by Educational Experience (VEE) General Information CIA Candidate
    • University Resources
      Universities & Colleges with Actuarial Programs (UCAP) CAE: Centers of Actuarial Excellence University-Earned Credit (UEC) Program Hickman Scholars Program Academic Benefits
  • Professional Development
    • Major Meetings
      Asia-Pacific Symposium China Symposium Health Meeting ImpACT Conference Middle East, Africa, S. Asia Symposium ReFocus Conference ValAct Meeting
    • Professional Development Edge
    • PD Tools & Resources
  • Research Institute
    • Research By Topic
      Aging & Retirement Artificial Intelligence Catastrophe and Climate COVID-19 Disability Diversity Equity & Inclusion Finance & Investment General Insurance Health Care Cost Trends Innovation & Technology International Life & Annuities Long-Term Care Mortality & Longevity Predictive Analytics & Modeling Risk Management U.S. Population Valuation/Illustrations
    • Experience Studies Pro
    • Tables, Calculators & Modeling Tools
    • Research Opportunities
      Sponsorships Proposal Requests Data Requests Calls for Papers Funding & Grants Competitions & Awards Academic & Student Research
    • Actuarial Research Clearing House (ARCH)
    • NAAJ Practical Application Essays
    • About the SOA Research Institute
      Strategic Research Programs Trending Research Recently Published Research Volunteer with the SOA Research Institute
  • Sections & Communities
    • Explore Evolution to Communities
      Evolution to Communities Community Governance Communities FAQs
    • Sections
      About SOA Sections Actuary of the Future Education & Research Entrepreneurial & Innovation Financial Reporting Health International Investment Joint Risk Management Leadership & Development Long Term Care Insurance Marketing & Distribution Modeling Predictive Analytics & Futurism Product Development Reinsurance Retirement Smaller Insurance Company Social Insurance & Public Finance Taxation Technology
    • Emerging Topics Community
  • Tools & Resources
    • Connections
      SOA Explorer SOA Engage SOA Cares Actuarial Clubs Actuarial Directory Listservs Employers
    • Actuarial Practice
      Mortality and Other Rate Tables (MORT) Relative Risk Tool Annuity Factor Calculator
    • Other
      Longevity Illustrators Actuaries Climate Index Predictive Analytics MentorLink
    • Publications
      The Actuary Magazine North American Actuarial Journal (NAAJ) SOA E-Newsletters Actuarial Books Writing Opportunities With the SOA
  • About SOA
    • About SOA
      Strategic Plan Diversity, Equity & Inclusion Societal Purpose
    • Governance
      Strengthening Our Board Board of Directors Elections Staff Leader Disciplinary Determinations
    • Membership
      Dues for Membership CPD Requirement Join an SOA Section or the Emerging Topics Community Read Member Obituaries
    • Newsroom
      SOA News SOA Board of Directors Communications
    • Topics in the News
      Predictive Analytics InsurTech
    • Volunteer Program
      Volunteer Opportunities SOA Awards
    • Contact SOA
      Customer Service Center Department Directory
    • Job Opportunities
      Job Center Careers at SOA
    • Legal Center

2023 Webcast - 10.30.23 - Hospital & Health Plan Price Transparency Webcast Recording

On-Demand

Online

Subscription Info

  • Event Overview

CMS has required hospitals to publish their chargemaster rates, cash discounts and negotiated rates as of January 1, 2021. Our panel is comprised of a data strategist, an executive from a large hospital system and an actuary.

Mr. Cardelle, Chief Strategy at AMS Intelligent Analytics, will focus on:

• An overview of the CMS Final Rule for Hospital Price Transparency & Health Plan Transparency in Coverage requirements, comparing some of the key differences between the two.

• A summary and status of data integrity, compliance with the Final Rule, and an update on the penalties for Non-Compliance.

• An overview of the Hospital Chargemaster (CDM) and the difference between Chargemaster Reconciliation and Chargemaster Validation and why this is important.

• A review of new Payment Integrity and Business Intelligence Use Cases

• Reported Price differences between Hospital published data and Health Plan published data.

Mr. Verrengia, Chief Operating Officer at Northwell Direct, will explore how the newly available Price Transparency information impacts the strategy, approach, and results of contracting for the hospitals & health systems. Areas of focus will include:

• What information and approach are health systems taking to secure this information, what components are most important, and which vendor partners have been most valuable to work with?

• What is the compliance rate for hospital participation in this endeavor and how does the potential for low compliance impact the strategy or negotiation results? What have been the barriers to compliance and why as well as what other challenges exist?

• What has been the experience with the data quality, both in the values and understanding episodic or bundled payments?

• Has the availability of price transparency data been an overall positive to hospital negotiations? If so, how? If not, why not?

• Has Price Transparency changed how hospitals approach pricing methodology and if so, how?

• Do hospitals see Price Transparency accomplishing what it was intended to do?

• What do we see for the future of Price Transparency for hospitals and payers?

Mr. Zhou, Actuarial Manager at Optum, will provide an overview on Machine Readable Files (MRFs) and a walkthrough of a MRF sample with focus on:

• How contract rates are presented and what's missing.

• Why payers are publishing billions of records.

• Removal of duplicates and irrelevant rates.

• An actuarial Use Case.

    Recording Details

  • Competency:
    • Actuarial Modeling and Analysis
    • Data Science, Analysis & Predictive Analytics
    • Generating Business Insights
    • Pricing and Product Development
    • Risk Management
    • Results-Oriented Solutions
    • Strategic Insight And Integration
    • Technical Skill And Analytical Problem Solving
    • Valuation and Financial Analysis
  • Credit:

    1.80 SOA CPD

    1.50 CIA

  • Presented By:

    Health Section

  • Customer Service Center
  • Department Directory
  • Newsroom
  • Job Center
  • Careers at SOA
  • Sponsorship Opportunities
  • Be An Actuary
  • Actuarial Directory
  • Actuarial Foundation
  • The Actuary Magazine
Go to Homepage
© 2025 Society of Actuaries
Linkedin
X
Facebook
Instagram
YouTube
WeChat
Weibo
Terms of Use
Privacy Policy
Cookie Policy
Transparency in Coverage
备案号:京ICP备2021008329号-1
京ICP备2021008329号-2
京公网安备 11010502044463号