The CMS (Centers for Medicare & Medicaid Services) price transparency rule, effective as of January 1, 2021, represents a significant shift in how healthcare providers communicate pricing information to patients. This rule mandates that hospitals publicly post standard charges for services and items they provide.
What are the key requirements of the CMS price transparency rule?
Under this federal mandate, hospitals must provide clear, accessible pricing information online about the items and services they offer. The rule generally requires comprehensive price lists. Hospitals must post a machine-readable file with standard charges, including discounted cash prices and payer-specific negotiated charges. Hospitals must also provide this information in a consumer-friendly format. This generally includes a minimum of 300 shoppable services that a healthcare consumer can schedule in advance. An exception to the minimum number requirement is available if a hospital does not offer 300 qualifying services.
Hospitals need to update this information annually to help better ensure ongoing compliance with the CMS rules.
What happens if a hospital fails to comply with this rule?
Failing to comply with the CMS price transparency rule can lead to significant legal repercussions for healthcare providers, as highlighted in a recent case. The CMS recently fined Baytown Medical Center in Texas over $50,000 for failure to have a publicly accessible website with the required information.
In addition to the hefty fines as noted in the example above, non-compliance can also harm a hospital’s reputation, potentially resulting in a loss of patient trust and a decrease in patient intake. As such, it is important for healthcare providers to understand these implications and take proactive steps to help better ensure they meet all requirements of the CMS price transparency rule.
How can I make sure my medical practice or hospital avoids a similar penalty?
It is important to carefully review the language of the law to determine if your facility qualifies as a hospital. In this case, CMS issued two notices of noncompliance before moving forward with penalties. Although it is possible the agency will provide similar notice to other facilities in the future, it is best to avoid the issue in the first place. Internal audits can help to identify any potential issues and provide a resolution before there is a problem, helping to better ensure compliance.
This law illustrates how the rules governing healthcare facilities are constantly evolving. Regular internal audits can review compliance not just for the transparency rule, but other federal regulations as well. This will help to mitigate the risk of violations and costly penalties.
Attorney John Rivas is responsible for this communication.