In the 2022 Proposed OPPS rule, CMS proposed increased penalties for non-compliance with the Hospital Price Transparency Final Rule.
Background
Through the price transparency rule, hospitals are required to provide clear, accessible pricing information for their payer-negotiated rates in a machine-readable format. It also requires them to provide a tool for consumers that allows them to easily search and view the prices for at least 300 shoppable medical services.
The pricing information must be:
- Displayed prominently
- Easily accessible
- Without barriers
- Easily searchable
Through their audits, CMS has identified and addressed non-compliant barriers that are prohibited.
Examples include:
- Requiring users to pass certain tests that prove they are human (identify certain numbers and letters that are distorted or certain images).
- Requiring the user to take additional actions after clicking the machine-readable link and before being able to download.
- Controls that prevent direct access to a single machine-readable file.
2022 Proposed Penalty Increase
Currently the civil monetary penalties (CMPs) are set at $300 per day. However through initial audits, CMS has found a significant number of hospitals are not complying.
To hold hospitals more accountable and incentivize them to comply, a CMP scalable system will be used. Fines will be assessed based on hospital bed count/size which will be determined from annual cost report data. If a hospital is not enrolled in Medicare, the bed size will be determined by data provided by that hospital.
Penalties will range from $300/day up to $5,500/day and will be imposed for all days the hospital is non-compliant starting with the effective date of the final rule.
- Hospitals with a bed count of 30 or less will be assessed a CMP of $300 per day.
- Hospitals with a bed count of 31 to 550 will be subject to penalties based on the number of beds times $10.
- Hospitals with a bed count of more than 550 will be assessed a CMP of $5,500 per day.
There may be circumstances in which CMS requires additional information due to errors or discrepancies. If additional information is required, hospitals must provide documentation of its number of beds in a form and manner outlined by CMS in their request and by the set deadline.
If not provided as requested, CMP would be assessed at the highest dollar amount per the sliding scale at $5,500 per day.
The penalties will be adjusted annually.
We recommend you read the entire Proposed Rule in order to identify all of the changes applicable to your facility. The HBE team is available to assist you with the implementation of these important changes as well as provide assistance in preparing your staff through education and training.
The Proposed Rule is available here: https://www.cms.gov/medicare/medicare-fee-for-service-payment/hospitaloutpatientpps
The CMS price-transparency website with a variety of resources including links to the final rule is available here: https://www.cms.gov/hospital-price-transparency
HBE’s team of coding and compliance experts is available to assist you with external reviews of your documentation, coding and reimbursement as well as providing customized education and training for your staff. We are also available to provide assistance with conducting risk assessments, internal investigations and policy and procedure development.
DISCLAIMER: This newsletter 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.
