Report recommends chargemaster best practices for price transparency

Almost a year after CMS required hospitals to post their chargemaster online, some hospitals are going beyond the basic requirements while others lag behind, according to an analysis released September 30 by ADVI, a business development group based in Washington, D.C.

The 2019 IPPS final rule required hospitals to post their list of standard charges online in a machine-readable format to support greater hospital price transparency. ADVI looked at the chargemasters posted by the top 25 hospitals by revenue as defined by the American Hospital Directory. The analysis aimed to evaluate best practices for complying with CMS’ rule and pinpointed areas for improvement as well as instances where hospitals improved upon CMS’ basic price transparency requirements.

ADVI’s analysis found that the chargemaster data posted by hospitals is not uniform. Although it’s expected that specific data will be different, variances in how the data is made available and the inclusion or exclusion of certain elements affected the usefulness and legibility of the data.

According to ADVI’s analysis, hospitals should review the following elements for improvement:

• Data elements. Data should be comprehensive and should clearly distinguish between the charge for the administration of a service, such as a pacemaker insertion, and the charge for an item itself (i.e., a pacemaker). Drugs should be identified by HCPCS codes and dosage. The language used in the charge description should be easily understood by a layperson.
• File format. Hospitals should make the format as user friendly as possible. The analysis noted that some hospitals include a searchable list of charges that is exported into a spreadsheet. This could be further improved on by creating a tool that auto populates or suggests search terms as users type in the search field.
• Location and accessibility. Hospitals should post the link to their standard charges in a location that is visible and logical, preferably on their homepage. Hospitals should limit the number of clicks needed to access the data and should not require users to enter their name or email address to download or access the file.
• Frequency and notification of updates. Chargemaster files posted online should be updated at least annually, if not more frequently. Although ADVI does not recommend a specific frequency for reviewing and updating these files, hospitals should include a clear date for when the files were posted and updated.
• Applicability. Hospitals should clearly state whether the charges apply to all facilities or to an individual hospital in the system.

The 2020 OPPS proposed rule expands on the 2019 IPPS final rule requirements, including defining terms such as “standard charges,” enforcing the policy through penalties, requiring the posting of 300 “shoppable” services, and asking for payer-specific pricing information. Industry organizations such as the American Hospital Association have already raised the possibility of legal action if the requirement to post payer-specific pricing information is included in the 2020 OPPS final rule.