Penalty for Price Transparency Noncompliance Could Get Steep

Thoughtware Alert Published: Sep 07, 2021
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Effective January 1, 2021, hospitals operating in the U.S. are required to make their standard charges for all items and services provided by the hospital publicly available in a comprehensive, machine-readable file. In addition, hospitals must make public, in a consumer-friendly format, standard charge information for 300 shoppable services. 

In the calendar-year 2022 Outpatient Prospective Payment System proposed rule, CMS shows no sign of backing off on the current requirements but instead proposes to amend several hospital price transparency policies to further encourage compliance. 

The most notable change to the price transparency requirement is a proposed increase to the amount of the monetary penalty for noncompliance through the use of a proposed scaling factor based on hospital bed count. While the current civil monetary penalty for noncompliance would not exceed $300 per day for any hospital, the proposed penalty of $10 per day per hospital bed for hospitals with more than 30 beds could increase penalties up to $5,500 per day for a hospital with more than 550 beds as summarized by CMS in the following table. 
 

CMS
 

Source: CMS CY 2022 OPPS Proposed Rule, Table 63

Additional proposed amendments to the price transparency policies include deeming state forensic hospitals that meet certain requirements to be in compliance with the requirements of 45 Code of Federal Regulations Part 180 and prohibiting certain conduct that CMS has concluded to be barriers to accessing the standard charge information. CMS also clarifies the expected output of hospital online price estimator tools when hospitals choose to use them to provide price estimates for shoppable services in a consumer-friendly format. 

CMS has prepared Hospital Price Transparency Requirements Quick Reference Checklists to assist hospitals with determining whether the hospital is meeting current price transparency requirements. The checklists can be found on CMS’ website here.

BKD’s Health Care Performance Advisory Services (HCPAS) professionals can help hospitals navigate the price transparency requirements and assist them in developing a plan for incorporating these requirements into the hospital’s overall pricing strategy. For more information, reach out to your BKD HCPAS trusted advisor or submit the Contact Us form below. 

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