Let’s talk about your EHR needs: 1.800.383.6278  

Tuesday December 26, 2023

How to Get the Most Out of CMS Price Transparency Rules

Since their introduction in January 2021, healthcare providers have largely overlooked the Centers for Medicare and Medicaid Services (CMS) price transparency regulations.

However, with CMS now imposing substantial fines for non-compliance, rural hospitals stand to gain from competitive pricing and enhanced digital engagement.

Understanding CMS Price Transparency Rules

Healthcare providers are required to compile and publicly display extensive billing data, including a machine-readable file of all standard charges and a consumer-friendly list of 300 shoppable services.

Shoppable services refer to non-emergency care where prices can vary among providers. For example, a patient requiring an MRI could compare costs for this procedure at different facilities in their region based on their insurance coverage.

Why Have Healthcare Providers Been Hesitant to Adopt Price Transparency?

A recent JAMA study found that about 51% of hospitals do not comply with CMS requirements.

Healthcare providers have been slow to comply with CMS price transparency rules because it is a complex and demanding process. Facilities must gather and update a wide range of information annually for each chargeable item, including gross charges, contracted prices with each payer, a discounted cash price, and the minimum and maximum negotiated prices.

Compliance also carries financial risks, such as revealing competitive disadvantages.

The healthcare sector's recovery from the pandemic has also influenced CMS's initial hesitation to enforce the penalty of $300 per day against non-compliant hospitals.

Increased Enforcement by CMS

Recently, CMS imposed significant fines on two Georgia healthcare providers, Northside Hospital Cherokee and Northside Hospital Atlanta, totaling over $1 million. This action indicates a more assertive approach to enforcement.

Going forward, CMS will audit hospital websites and review public complaints to assess compliance. Non-compliant providers will receive a warning, a request for corrective action, and potentially a civil monetary penalty, which will be publicized.

This development is an alert for larger providers lagging in compliance, but it offers an opportunity for rural hospitals to improve their market position.

Benefits for Rural Hospitals

Competitive Pricing

Rural healthcare providers frequently offer lower prices than urban hospitals, rendering them more appealing to cost-conscious patients.

Enhanced Revenue

An increased customer base can significantly benefit remote hospitals struggling financially. Adopting price estimation and contract management technologies can provide accurate financial expectations for patients and ensure correct payer reimbursements.

Better Digital Patient Experience

Providing online price estimates can increase customer satisfaction. A comprehensive digital patient experience includes eStatements, online bill payment, and digital support, as well.

MEDHOST Price Transparency Solution

MEDHOST offers a solution to help hospitals display accurate, current pricing and leverage digital tools for improved patient care and revenue.

This includes a web-based search page for the 300 shoppable services, automatic generation of comprehensive, standard charges, integration with contract management tools, and minimal disruption to existing customer workflows.

For more information, reach out to us at or call 1.800.383.6278.

You may also be interested in: