In late 2019, the Centers for Medicare & Medicaid Services (CMS) announced the hospital price transparency rule, which requires hospitals — beginning on Jan. 1, 2021 — to provide publicly accessible standard charge information about the items and services they render.
That includes gross charges, discounted cash prices, de-identified minimum and maximum negotiated charges, and even payer-specific negotiated charges for 300 “shoppable” services in a consumer-friendly, searchable format on their website. Hospitals choosing not to comply with the new mandate could be subject to a $300 per day fine.
Late last year, CMS sent a Special Edition email to Medicare providers stating plans to audit a sample of hospitals for compliance starting in January, in addition to investigating complaints that are submitted to CMS and reviewing analyses of non-compliance. Hospitals may also face civil monetary penalties for noncompliance.
The email further outlined CMS’ plans to audit hospital websites and if the agency finds the hospital to be non-compliant with one or more of the requirements in the price transparency rule, it will provide a written warning identifying the specific violation(s) and later request a corrective action plan if hospital non-compliance constitutes a “material violation” of one or more requirements.
A material violation includes failing to make public its standard charges or make standard charges public in the form and manner required by the overall price transparency rule, which includes presenting the information in a machine-friendly format on the hospital website.
To help hospitals comply with the mandate, Wipfli has assembled a team of specialized health care and technology consultants to deliver a solution. The Wipfli team provides health care organizations with necessary data files and web interfaces, so your team can easily display the information on your website. More information about Wipfli’s price transparency solutions is available in this fact sheet.
Wipfli is an endorsed business partner of Hospital Council.