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CMS to Begin Hospital Price Transparency Audits

CMS to Begin Hospital Price Transparency Audits January 12, 2021

CMS will begin auditing  hospital compliance with the Hospital Price Transparency requirements.  The audits are expected to begin this month. CMS will also continue to  investigate complaints related to non-compliance which can result in civil monetary penalties (CMP). The Hospital Price Transparency Final Rule requires every hospital in the United States to provide publicly accessible, online, standard charge information about the items and services they most commonly provide. The information must be provided in two separate formats:

  • Comprehensive machine-readable file with all items and services
  • Display of 300 shoppable services in a consumer-friendly format

The Final Rule also outlines CMS’s monitoring and enforcement plan which includes:

  • Evaluation of complaints made by individuals or entities to CMS
  • Review of individuals’ or entities’ analysis of noncompliance
  • Audit of hospital websites

The following actions, which generally occur in the following order, may be taken if CMS determines a hospital is noncompliant with one or more of the requirements:

  • Provide a written warning notice to the hospital of the specific violation(s)
  • Request a Corrective Action Plan (CAP) if noncompliance constitutes a material violation of one or more requirements
  • Impose a civil monetary penalty not in excess of $300 per day and publicize the penalty on a CMS website if the hospital fails to respond to their request to submit a CAP or comply with the requirements of a CAP

HBE recommends reviewing your institution’s current policies and practices, as well as conducting routine internal audits, in order to ensure compliance with all of the requirements found in the Hospital Price Transparency Final Rule.

You can also visit the Hospital Price Transparency website for additional information and resources to help your institution ensure compliance.   As always, HBE’s team of experts is available to assist you with conducting risk assessments, routine auditing and monitoring, policy and procedure development as well as customized education and training for your clinical and administrative staff.

DISCLAIMER:  This newsletter only contains summary information and highlights; it should be read in conjunction with the full article or document provided as a link.  Any advice or recommendations are general and specific questions should be directed to professional counsel.

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