The RAND Corporation recently released its latest hospital price transparency study, analyzing the rates that private insurers pay hospitals and ambulatory surgical centers (ASCs) across the United States. The findings, based on claims data from 2022, continue to shed light on the wide variation in prices—and the implications are particularly relevant for emergency medicine providers and freestanding ERs.
Here’s what you need to know—and how it could impact your operations.
Key Findings from the RAND Study
- Private insurers paid hospitals, on average, 254% of Medicare rates for the same inpatient and outpatient services in 2022.
- Prices for hospital outpatient services averaged 285% of Medicare rates, while inpatient services averaged 241%.
- Significant variation exists not only between states but also among hospitals within the same region.
- Ambulatory surgical centers, while paid lower rates than hospitals, still received approximately 150% of Medicare on average.
This study highlights a familiar but important issue: payment inconsistency remains a systemic challenge—and emergency care providers often feel the brunt of it.
What This Means for Emergency Medicine and Freestanding ERs
1. Negotiating Payer Contracts Requires Strong Data
Wide variations in reimbursement reinforce the need for providers to understand their own payment benchmarks—and how they compare to peers. Without accurate data, it’s difficult to negotiate fair rates or challenge underpayments.
At QMACS, we support our clients with contract analysis and performance benchmarking so they can enter negotiations fully informed.
2. Transparency Will Continue to Drive Accountability
As pricing data becomes more accessible through reports like RAND’s, providers should expect increased scrutiny from patients, regulators, and payers. Emergency departments must be prepared to explain and defend their pricing structures—especially in out-of-network scenarios.
Our team helps emergency groups navigate this landscape by aligning billing processes with documentation, coding, and payer expectations.
3. IDR Submissions Need Real-World Rate Justification
In the context of the No Surprises Act, the RAND study provides further evidence that payment disputes aren’t just about “usual and customary” rates—they’re about payer practices and regional norms. IDR submissions that leverage this kind of data have a stronger chance of success.
QMACS offers end-to-end IDR support, helping clients compile the data and documentation needed to support their position.
Preparing for What’s Next
The RAND report underscores the continued need for financial transparency, consistent documentation, and strategic revenue cycle management. Emergency medicine providers can’t afford to operate without clear insights into how they’re being paid—and how they should be paid.
As pricing data becomes more public, it’s critical to:
- Review and update payer contracts regularly
- Monitor underpayments and outliers
- Use benchmark data to guide negotiations and dispute resolution
QMACS helps emergency departments and freestanding ERs stay ahead of these challenges with revenue cycle strategies that combine compliance, clarity, and control.
Need help making sense of your reimbursement rates—or preparing for IDR?
Let QMACS help you turn data into action.
Contact us today to learn more about how we support emergency providers nationwide.