Price Transparency Rule Now In Effect: What you Need To Know

The Price Transparency mandate from The Centers of Medicare & Medicaid Services (CMS) was designed to provide patients with the ability to manage their healthcare through published prices for services and procedures.

This mandate creates opportunities for hospitals to create better patient experiences with enhanced financial clarity, but non-compliance risks fines and reputational consequences for hospitals beginning January 1, 2021. Greater risks may result from litigation or lost revenues from perpetuating poor billing practices.

The initial version of CMS’s price transparency rule was effective in January 2019. It required that hospitals publish standard list prices in a machine-readable format online. Enhancements to this initial rule were finalized in November 2019. The final rule requires hospitals to provide a consumer-friendly and searchable display of 300 shoppable services including gross and discounted cash prices, payer specific charges, and de-identified minimum and maximum charges on a publicly accessible website. This information must also be included in a machine-readable file. Legal challenges to the ruling and requests for delays due COVID-19 failed and the rule went into effect on January 1, 2021 as planned.1

This final rule comes with strict monetary penalties. Hospitals that do not meet the requirements under this rule may be subjected to a $300 per day fine, as well as the potential to lose Medicare payments altogether. Since mid-January, CMS has also publicly identified noncompliant hospitals by naming them on the CMS website. This disclosure not only affects a hospital’s reputation but creates a tort bar practice development tool.

CMS has announced that it has started auditing a sample of hospitals to ensure compliance with the rule and is asking the public to report noncompliance through a form on their website. Patients are encouraged to notify CMS if they can’t find a hospital’s standard charges online.

A noncompliant hospital may be asked to provide CMS with a corrective action plan. If the corrective action plan is not provided in a timely manner, then CMS will initiate monetary penalties and public shaming. Currently, CMS is not allowing hardship waivers or exemptions.

The Price Transparency solution from MEDHOST enables providers to comply with Price Transparency Policy. Learn more about how we can help you become compliant by contacting us at inquiries@medhost.com or calling 1.800.383.6278.

1 https://www.cms.gov/hospital-price-transparency

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