Are You Ready to Comply with CMS Hospital Price Transparency?
Starting on January 1, 2021, the Centers for Medicare and Medicaid (CMS) requires each hospital operating in the United States to provide clear, accessible pricing information online about the services they provide. Each hospital is required to make this information available in two ways: 1.) In a comprehensive machine-readable file with all items and services (CMS 8 Steps to a Machine-Readable Fill for All Items & Services), and 2.) In a consumer-friendly display showing standard charges for at least 300 ‘shoppable’ services that are provided by the hospital, including corresponding ancillary services, if applicable. (CMS 10 Steps to Making Public Standard Charges for Shoppable Services) There are four types of standard charges your hospital is required to provide in your consumer-friendly display when applicable:
Discounted cash price that applies to an individual who pays cash, or cash equivalent
Charge that the hospital has negotiated with any third party payer
De-identified minimum negotiated charge, which is the lowest charge that a hospital has negotiated with all third-party payers for the shoppable service
De-identified maximum negotiated charge which is the highest charge that a hospital has negotiated with all third-party payers for the shoppable service
According to the CMS Hospital Price Transparency webpage, monitoring and enforcement of these price transparency requirements will begin January 1, 2021. For hospitals that do not comply, they may issue a warning notice, request a corrective action plan, impose a civil monetary penalty, and publicize the penalty on a CMS website. CMS will be providing a Price Transparency webcast on December 8, 2020, to give an overview of the price transparency resources and answer questions regarding the requirements
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