CMS releases additional information on 2019 IPPS price transparency requirements

Wednesday, December 12, 2018

On December 4, CMS released additional FAQs regarding the 2019 IPPS final rule requirement that hospitals post a list of their standard charges on the internet. The requirement, which goes into effect January 1, has rattled many hospitals and left them rushing to meet the effective date.

As published in the final rule, the requirement left many implementation specifics unanswered. Providers have expressed concern about CMS’ definition of standard charges, whether hospitals are allowed to post proprietary CPT code descriptions, and whether CMS expects all services and items to be included rather than only those typically listed in the chargemaster. CMS released FAQs in October that addressed some of these questions but many others remain unresolved.

The most recent FAQs provide additional clarity on key points such as the types of facilities to which the requirement applies and items that must be included in the list of standard charges. Inpatient rehabilitation Facilities, inpatient psychiatric hospitals, critical access hospitals, and sole community hospitals must comply with the requirement. In addition, the requirement applies to drugs, biologicals, and other items and services that generally do not have standard charges listed in the chargemaster.

CMS also took the opportunity to remind subsection (d) hospitals that under current guidelines they are still additionally required to establish, update, and make public a list of their standard charges for each diagnosis-related group.

However, the FAQ does not include additional information on specific penalties for noncompliance. CMS stated that enforcement or other actions will be address in future rulemaking.

Hospitals concerned about the legality of posting proprietary CPT code descriptions did receive some assurance. At the CPT Symposium in November, the AMA stated that facilities that have a valid and current CPT content license may report CPT codes when complying with the 2019 IPPS final rule.

Editor's note: This article originally appeard on Revenue Cycle Advisor.