CMS issues first penalties for price transparency rule violations

Wednesday, June 15, 2022

On June 8, CMS issued its first penalties for violations of the Hospital Price Transparency final rule to two Georgia hospitals in the same health system, Northside Hospital Atlanta and Northside Hospital Cherokee.

The rule states that hospitals must have two lists posted on their website: a comprehensive list of all hospital service prices and a list showing the shoppable common services. After not making their prices public nor replying to the warning letters they received from CMS, the two hospitals received fines totaling approximately $1.1 million.

Although these fines were the first ones to be issued, numerous reports have found that many hospitals are not in compliance. Recently, a report from Rice University’s Baker Institute found that many top-ranked hospitals fail to meet the rule’s requirements. On June 7, JAMA published research that found only 6% of hospitals covered by the rule are in compliance.

Revenue integrity professionals should ensure that their organizations are in compliance with all requirements of the rule. If their organization is not in compliance with one or more requirement, steps must be taken to address these gaps. Compliance with state and federal hospital price transparency requirements should be included in internal audit plans, and the organization’s compliance status should be communicated to the executive level.

Editor’s note: Access more NAHRI resources on price transparency here.

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Compliance, News, Revenue Integrity