Last week CMS announced enforcement updates related to hospital price transparency and issued a new fact sheet for providers. The hospital price transparency rules were effective January 1, 2021 and require hospitals to publish their charges for items and services in a specified, consumer-friendly format.
CMS has been conducting audits of hospital compliance with the price transparency rules and have issued civil monetary penalties (CMPs) to hospitals found to be non-compliant. To date, four hospitals have been issued CMPs. Additionally, CMS has issued over 730 warning notices and 269 requests for corrective action plans (CAP).
The CMP notices are available on the CMS website and include the following types of violations:
- Failure to publish all payer specific negotiated rates
- Failure to publish discounted cash prices
- Failure to include at least 300 shoppable services
- Failure to publish information in a single, digital file
- Failure to include item descriptions
- Failure to include CPT, HCPCS, and DRGs
CMS is making process updates in an effort to increase hospital compliance with the price transparency requirements. The changes include:
- Compliance with CAPs within 90 days of the CMS CAP request with automatic CMPs for failure to comply.
- Automatic CMPs for failure to submit a CAP within 45 days
- Automatic CMPs for hospitals who have made no effort to comply with the price transparency regulations (those with no machine-readable file or price estimator tools)
We recommend conducting an audit of your price transparency compliance. Specific attention should be given the types of violations included in the published CMPs.
The CMS Fact Sheet is located at: https://www.cms.gov/newsroom/fact-sheets/hospital-price-transparency-enforcement-updates
CMS Price Transparency resources are located at: https://www.cms.gov/hospital-price-transparency
CMS List of CMPs issued to date are located here: https://www.cms.gov/hospital-price-transparency/enforcement-actions