CMS launches Hospital Price Transparency website for hospitals and patients

Wednesday, October 21, 2020

CMS recently launched a Hospital Price Transparency website to help hospitals prepare to comply with price transparency requirements effective January 1, 2021. The website includes an overview of key provisions, dates, and monitoring and enforcement. It also includes information for patients on how they can use price transparency information, and resources.

Many hospitals have spent the better part of the year grappling with the novel coronavirus (COVID-19) pandemic. Faced with a shortage of resources and staff, preparing to comply with the new price transparency requirements may have been moved to the back burner. However, experts agree that it’s unlikely CMS will delay the effective date or implement a compliance grace period.

Hospitals must ensure that they understand what requirements go into effect January 1, 2021, how CMS will conduct monitoring and enforcement, and the risks of noncompliance.

Who needs to comply?

The requirements apply to most licensed hospitals. Refers to 45 CFR §180.20 for the definition of hospital. Certain federally owned or operated facilities already considered in compliance with the new requirements are detailed at 45 CFR §180.30.

What do we need to post?

Hospitals will be required to post standard charges as a single machine readable file and as a consumer friendly listing of 300 shoppable services.

What needs to be included in the machine readable file?

The machine readable file must contain standard charges for all items and services provided by the hospital. Details on the required data elements, format, and other technical requirements are included at 45 CFR §180.50.

How does CMS define “standard charges”?

CMS uses “standard charges” as an umbrella term for the following four specifically defined types of charges:

  1. De-identified minimum and maximum negotiated charges
  2. Discounted cash prices
  3. Gross charges
  4. Payer-specific negotiated charges

 

Refer to 45 CFR §180.50 for detailed explanations of the definitions and requirements.

What needs to be included in the list of shoppable services?

A shoppable service is a service that a patient can schedule in advance. The list of shoppable services must include 70 services selected by CMS and 230 services selected by the hospital. The list must have plain language descriptions of the shoppable services and group them with ancillary services. The list must also provide the following:

 

Alternatively, hospitals can use a patient-facing price estimator tool to fulfill this requirement.

See 45 CFR §180.60 for additional details on this requirement and use of a price estimator tool.

How will CMS monitor for compliance?

CMS will evaluate complaints made by individuals or entities, review analyses of noncompliance, and audit hospital’s websites. See 45 CFR Subpart C for additional details on how CMS plans to monitor hospitals’ compliance.

How will CMS address noncompliance?

If CMS determines that a hospital is noncompliance with one or more requirements the agency may take several actions. First, CMS may issue a warning notice to the hospital explaining the specific violation. If the violation constitutes a material violation, CMS may request a corrective action plan. Finally, if the hospital does not submit a corrective action plan or comply with a corrective action plan, CMS may impose a civil monetary penalty and publicize the penalty on its website.

In this case, a material violation means that a hospital has failed to make public its standard charges:

 

Review 45 CFR §180.70 and 180.80 for detailed information on enforcement.

How much would the civil monetary penalty be?

The maximum daily amount for a civil monetary penalty will be $300. There are two things to keep in mind:

  1. This is a daily amount, meaning that if a hospital is noncompliant for 182 days the maximum penalty would be $54,600, and if it is noncompliant for 365 days the maximum penalty would be $109,500.
  2. The maximum per day penalty is $300 even if a hospital is in violation of multiple requirements. However, CMS has not published information on the minimum penalty or how penalties will be calculated, so hospitals don’t have a resource that maps specific violations to ranges of monetary penalties.

 

Refer to 45 CFR §180.90 for complete information on civil monetary penalties.

Resources

These NAHRI resources help revenue integrity professionals understand the requirements and how they will impact their jobs:

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