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
annually.
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:
- Psychotherapy
- Consultations
- Preventive Medicine Services
- Routine Labs
- CT/MRI services
- Mammography Services
- Obstetrical Care
- Surgical Services
RECOMMENDATIONS
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