CMS has sent its first wave of warning letters out to hospitals who have not complied with federal rules requiring them to disclose payer-negotiated prices. The Hospital Price Transparency final rule requires hospitals to publish a machine-readable file online that outlines their payer-negotiated payment rates. It also requires hospitals to provide a tool that allows consumers to search and view the prices of 300 shoppable medical services.

Hospitals that received a warning were given a 90-day window to address shortcomings outlined in the letter. CMS can then choose to either:

• Close the inquiry
• Deliver a second warning letter
• Request a corrective action plan from the hospital
• Impose civil monetary penalties and publicly name the hospital on the CMS website

CMS has yet to publicly name any organizations at this time as prematurely releasing the names of those hospitals could harm organizations that have already updated their online pricing information or are in the process of doing so. If your hospital is not in compliance with the price transparency rule, we recommend you implement the requirements as soon as possible to avoid potential fines and penalties. 

CMS maintains a variety of price transparency resources which are located at https://www.cms.gov/hospital-price-transparency

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 contains only 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