CMS publishes sample formats to support hospital price transparency compliance
CMS recently released new hospital price transparency sample formats. The formats, which come in wide, tall, and plain, may be used by hospitals to meet the requirement to make standard charges publicly available in a machine-readable file. The agency also released a sample data dictionary that may be used with the wide and tall formats.
Hospitals are not required to use the sample formats but may adopt them on a voluntary basis.
CMS’ Hospital Price Transparency rule requires hospitals to post five types of standard charges for all services in a machine-readable file and a separate consumer-friendly file or price estimator for at least 300 shoppable services.
The requirements went into effect January 1, 2021, but according to a report released in August by PatientRightsAdvocate.org, only 16% of hospitals are in compliance with all requirements. The report also found that two of the three largest health systems are completely noncompliant.
Other sources support the low rate of compliance throughout the industry. A JAMA study published in June found that less than 6% of hospitals were compliant with the requirement to post a machine-readable file and consumer-friendly file or price estimator.
CMS issued its first penalties for violations of the requirements in June. Two Georgia hospitals in the same system were fined approximately $1.1 million in total.
In October, the Office of Inspector General (OIG) announced that it plans to audit CMS’ monitoring and enforcement of the rule. The OIG expects to release a report on its findings and recommendations in 2023.
As the end of the year approaches, revenue integrity professionals should ensure that price transparency compliance is baked into annual chargemaster maintenance. Identify and address compliance gaps and provide education on the requirements when necessary. Consider whether using CMS’ new sample formats could streamline and improve your organization’s compliance efforts.
Editor’s note: Find more NAHRI resources on price transparency here.