Hospital Price Transparency - CMS Final Rule Update
Hospital Price transparency is a part of the Public Service Act and was established to make public the cost of services by hospitals. This service went into effect on January 1 of 2021. The data format to display the pricing for these services should include the gross charges, any discounted fees, and the negotiated payment rate with payer for the hospital service. In addition, a consumer friendly data file must be available in an easily readable format with as many services as the hospital provides or a minimum of 300 services if the hospital provides more than 300 services.
The hospital may also offer a price estimator that generates out of pocket costs for the shopper based on their individual insurance plan. CMS does have a plan in place to monitor the compliance of this regulatory requirement that consist of the following:
- Following up on complaints from the public
- CMS reviews
- Audits of hospitals websites
The enforcement process consists of a warning notice with an option and time enforced date to correct for the first violation. If this is not corrected within the allotted time period, the hospital may be fined as much as $300/day, for each day of non-compliance, for hospitals with 30 or less beds and even more per day for larger hospitals. CMS has recently issued updates to the enforcement that will shorten the time hospitals will have to come into compliance with the Price Transparency Regulations. In addition, CMS has posted a list of Hospitals that have been fined for non-compliance.
For a list of these hospitals that were fined, refer to the link: https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions
As of July 1, 2024 the final rule with the latest formats went into effect requiring all hospitals to have adopted the approved CMS templates, in compliance with its standard charges, in the required format.
Standard Charges must be posted in one of two ways:
Machine Readable File
- Single machine-readable digital file containing the following standard charges for all items and services provided by the hospital: Gross Charges, Discounted Cash Prices, Payer-specific Negotiated Charges, and De-Identified minimum and maximum negotiated charges.
Consumer-Friendly Display of Shoppable Services
- Display of at least 300 “shoppable services” (or as many as the hospital provides if less than 300) that a health care consumer can schedule in advance. Must contain plain language descriptions of the services and group them with ancillary services, and provide the Discounted Cash Prices, Payer-specific negotiated Charges, and de-identified minimum and maximum negotiated charges.
For additional details on these requirements, including the use of price estimator tools, refer to 45 CFR §180.60
For additional general information or assistance, CMS has a Hospital Price Transparency page on their website along with a Frequently Asked Questions
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