Last November, CMS finalized the proposed hospital price
transparency rules which will be effective
January 1, 2021. The final rule requires hospitals to
publish standard charges, including discounted and negotiated rates, for
all items and services in a specified online format as well as update the files
Included in the final rule is the requirement for hospitals to publish standard charges for 300 “shoppable” services. A “shoppable” service is defined as a service that can be scheduled by a health care consumer in advance. The services must be displayed and packaged in a consumer-friendly manner. This means the language must be understandable to patients and include all ancillary services, facility fees, and service charges so the patient can assess the entire episode of care. The data must also be easily searchable based on the description, code or payer.
The final rule indicated that CMS would identify 70 mandatory services to be included in “shoppable” services. The remaining 230 services may be selected by the hospital but must be services that are commonly provided to the hospital’s patient population and selected from the following categories of “shoppable” services: evaluation and management, laboratory and pathology, radiology and medicine/surgery services.
CMS has unveiled the 70 mandatory “shoppable” services which must be reported by hospitals. These services include:
- Preventive Medicine Services
- Routine Labs
- CT/MRI services
- Mammography Services
- Obstetrical Care
- Surgical Services
Although numerous lawsuits have been filed in an effort to delay and modify the transparency rules, there has not been an official delay. With less than a year to comply, hospitals can not afford to delay their implementation efforts. If you have not already, we recommend you read the complete Final Rule now and develop a committee and formal implementation plan to ensure compliance and avoid penalties. HBE’s team of experts is available to assist you with this process.
The Final Rule can be accessed here: https://www.hhs.gov/sites/default/files/cms-1717-f2.pdf
The mandatory “shoppable” services can be accessed here: https://www.cms.gov/files/document/2019-12-03-hospital-presentation.pdf