Transparency & the TMA Suit: Major Updates
Cate Brantley, JD
June 11, 2025
It has been a few weeks since my last legislative update, and while quite a bit has happened during the interim, I’m going to brief
The misconception is having to charge everyone the same price.
There are so many misunderstandings about healthcare pricing and how it works. One of the most common is that that many believe there is a legal requirement to charge everyone the same price. This is not even close to accurate. Instead, it is a great example of a widely held view that is wrong.
I think the origin of the misconception is the idea that discrimination is inherently illegal. It is not. In fact, in many situations, discrimination is highly advisable. For example, if you are choosing a surgeon, you don’t want to select one randomly from across the population. For starters, you want a doctor. I would choose a physician who is a fan of the scientific method, not someone practicing under the name Dr. Demento. And I would choose Hawkeye Pierce over Frank Burns.
In most situations, you want to discriminate against the incompetent. That type of discrimination is permissible, as it’s not done for any illegal reason. In many contexts, the law rightly prevents discrimination that is based on race, gender, national origin, and other protected classes. For that reason, it would be improper to charge women more than men for the same service. But other forms of price discrimination are permitted.
Antitrust aficionados may be thinking, “wait, I’ve heard price discrimination is illegal.” There is indeed a federal law, the Robinson-Patman Act, that prohibits price discrimination. But it applies to goods, not services. Professionals like physicians, lawyers, plumbers, and auto mechanics are free to charge people different rates for identical services.
One of the things that surprises me is how some people believe there is an obligation to charge everyone the same rate, while still being fully aware of the different reimbursement rates paid by payors. If it was true that you needed to charge everyone the same rate, would the disparity between Medicaid payment and Blue Cross Blue Shield reimbursement be permissible?
A common retort is that “we put the same charge on the bill to all patients, the difference is the amount paid by the insurer. But we are charging everyone the same rate.” There is some merit to that argument, but there is the genuine question of whether you can argue that the amount on a bill is your “charge” when you know in advance that the patient/payer will not pay that amount. It is pretty easy for someone to argue that if there is a dollar amount that you expect to take as payment in full when you send your bill, that figure is your “charge,” regardless of what appears on the invoice.
Later today I’ll be doing a webcast for RACuniversity exploring pricing issues. It will explain the state of the law in this complicated area, and also offer some thoughts about the hospital price transparency rule that takes effect Jan. 1, 2021. As we head into the Perseid meteor shower and the shortening days of August, it’s a gentle reminder that the season is going to change and that the new year is fast-approaching. If you have a question about healthcare pricing and you plan to tune in to the webcast, feel free to send me an email and I will do my best to answer it during the broadcast.
Programming Note: Healthcare attorney David Glaser is a permanent panelist on Monitor Mondays. Listen to his live report, “Risky Business,” every Monday at 10 a.m. EST.
It has been a few weeks since my last legislative update, and while quite a bit has happened during the interim, I’m going to brief
Price transparency in healthcare has long been a stated priority for the Trump Administration, both the first and second, and several recent public moves have
Please log in to your account to comment on this article.
Accurately determining the principal diagnosis is critical for compliant billing, appropriate reimbursement, and valid quality reporting — yet it remains one of the most subjective and error-prone areas in inpatient coding. In this expert-led session, Cheryl Ericson, RN, MS, CCDS, CDIP, demystifies the complexities of principal diagnosis assignment, bridging the gap between coding rules and clinical reality. Learn how to strengthen your organization’s coding accuracy, reduce denials, and ensure your documentation supports true medical necessity.
Denials continue to delay reimbursement, increase administrative burden, and threaten financial stability across healthcare organizations. This essential webcast tackles the root causes—rising payer scrutiny, fragmented workflows, inconsistent documentation, and underused analytics—and offers proven, data-driven strategies to prevent and overturn denials. Attendees will gain practical tools to strengthen documentation and coding accuracy, engage clinicians effectively, and leverage predictive analytics and AI to identify risks before they impact revenue. Through real-world case examples and actionable guidance, this session empowers coding, CDI, and revenue cycle professionals to shift from reactive appeals to proactive denial prevention and revenue protection.
Sepsis remains one of the most frequently denied and contested diagnoses, creating costly revenue loss and compliance risks. In this webcast, Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, provides practical, real-world strategies to align documentation with coding guidelines, reconcile Sepsis-2 and Sepsis-3 definitions, and apply compliant queries. You’ll learn how to identify and address documentation gaps, strengthen provider engagement, and defend diagnoses against payer scrutiny—equipping you to protect reimbursement, improve SOI/ROM capture, and reduce audit vulnerability in this high-risk area.
Only ICD10monitor delivers what you need: updates on must-know changes associated with the FY26 IPPS, including new ICD-10-CM/PCS codes, CCs/MCCs, and MS-DRGs, plus insights, analysis and answers to your questions from two of the country’s most respected subject matter experts.
Get clear, practical answers to Medicare’s most confusing regulations. Join Dr. Ronald Hirsch as he breaks down real-world compliance challenges and shares guidance your team can apply right away.
Federal auditors are zeroing in on Inpatient Rehabilitation Facility (IRF) and hospital rehab unit services, with OIG and CERT audits leading to millions in penalties—often due to documentation and administrative errors, not quality of care. Join compliance expert Michael Calahan, PA, MBA, to learn the five clinical “pillars” of IRF-PPS admissions, key documentation requirements, and real-life case lessons to help protect your revenue.
During this essential RACmonitor webcast Michael Calahan, PA, MBA Certified Compliance Officer, will clarify the rules, dispel common misconceptions, and equip you with practical strategies to code, document, and bill high-risk split/shared, incident-to & critical care E/M services with confidence. Don’t let audit risks or revenue losses catch your organization off guard — learn exactly what federal auditors are looking for and how to ensure your documentation and reporting stand up to scrutiny.
Learn how to navigate the proposed elimination of the Inpatient-Only list. Gain strategies to assess admission status, avoid denials, protect compliance, and address impacts across Medicare and non-Medicare payors. Essential insights for hospitals.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
