OIG to audit CMS for price transparency enforcement

The Office of Inspector General (OIG) recently announced it will audit CMS’ monitoring and enforcement of the Hospital Price Transparency final rule. The report is expected for release in 2023.

“We will review the controls in place at CMS and statistically sample hospitals to determine whether CMS’ controls are sufficient to ensure that hospital pricing information is readily available to patients as required by federal law,” said the OIG.

The OIG will also evaluate the extent to which CMS enforces the rule. CMS previously said hospitals in noncompliance with one or more of the rule’s requirements may receive a written warning notice, a request for a corrective action plan, and civil monetary penalties (CMP).

In June, CMS issued its first CMPs for violating the Hospital Price Transparency rule to two Georgia hospitals in the same health system. The hospitals were collectively fined approximately $1.1 million after they failed to respond to notices and provide corrective action plans.

Price transparency guidelines were first introduced in late 2019 but didn’t go into effect until January 1, 2021. Since then, hospitals have been required to clearly list their pricing information online in the following two ways:

• As a comprehensive machine-readable file with all items and services
• In a consumer-friendly display or tool for at least 300 shoppable services

“If hospitals are not in compliance with CMS' rule for listing their charges, we will contact the hospitals to determine the reason for noncompliance and determine whether CMS identified the noncompliance and imposed consequences on the hospitals,” said the OIG on its upcoming audit.

In August, PatientRightsAdvocate.org issued a report assessing the extent to which systems are adhering to the rule. The report showed 16% of 2,000 sampled hospitals in full compliance and 5.1% in “total noncompliance.” Additionally, the report showed the two Georgia hospitals who were issued CMPs by CMS are now in full compliance.

Revenue integrity professionals should ensure their organizations are in compliance with all provisions of the Hospital Price Transparency final rule. Add price transparency to internal audit plans and make sure public-facing price information is current.

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