Price transparency fight focuses on billing fine print

State of play: The fight surrounds efforts by the nonprofit PatientRightsAdvocate.org to make the contents of a widely used industry billing manual public, in the belief it's essential for patients and employers to understand what they're being charged.

• The American Hospital Association, which sells the manual and holds a copyright on it, is suing in the U.S. District Court for the Northern District of Illinois, arguing that it amounts to copyright infringement.
• The hospital industry is "dedicated to improving price transparency," but making a proprietary manual public doesn't help that cause, the trade group argued.

The manual contains standardized billing codes and instructions that hospitals and insurers use to process payments and essentially serves as the backbone of the modern billing system.

• The AHA has a copyright on the manual and leads a committee of health care stakeholders — including government payers — that updates it annually.
• The licensing agreement prohibits users from disseminating its content.

Before AHA began to standardize billing practices in the 1970s, each payer used its own codes and forms, which led to delayed payments, duplicative medical work and inefficiencies, per the hospital group's lawsuit.

• The federal government and many states have embraced the standardized system and require providers to use the instructions for medical billing.

Zoom in: Patient Rights Advocate argues that since government administrators are on the committee that updates the manual and it's part of federal and state electronic billing regulations, it can't be copyrighted.

• The advocacy group has asked the court to dismiss AHA's lawsuit.
• "AHA's restrictive approach ... undermines the public's ability to understand the convoluted health care billing system," Patient Rights Advocate's motion reads.

Yes, but: AHA says while governments use the manual, they don't create the content.

• The contents "tell consumers nothing about the prices that payers and providers chose to charge for those past services or what they would charge today," AHA wrote.
• It costs money to maintain and update the manual each year, and losing the rights to it would undermine AHA's ability to continue the standardized billing framework, it said.

The big picture: Health price transparency is becoming more important to consumers with the rise of high-deductible plans that require them to pay more out of pocket, said David Glaser, a lawyer at Fredrikson who works with hospitals on billing and other issues.

• "Will the average person be able to look at [the codes and forms] and make a lot of sense out of it? Probably not," he said. "But should you have that right? Yeah, you probably should."

What we're watching: Whether patients have any easier time comparison shopping for hospital services if the court sides with Patient Rights Advocate.