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CMS sending price transparency violation letters to hospitals

Jun 06, 2021

Hospitals not in compliance with the federal government’s price transparency rule have received their first warning letter.

The hospital price transparency regulation requires hospitals to publish the prices they negotiate with insurers It also requires hospitals to publish 300 shoppable service items in a consumer-friendly format.

About two-thirds of the country’s largest hospitals are not fully complying with the new regulations, which went into effect on Jan. 1, says the Centers for Medicare and Medicaid Services (CMS), which began reviewing complaints and analyzing hospitals for compliance.

Those who are not in compliance, face a maximum penalty of $300 each day that are not in compliance. They also will be required to publish that penalty. But first, hospitals will be issued a warning and receive a request for corrective action.

“While the hospital price transparency final rule indicates that once CMS issues a civil monetary penalty, CMS will make public the name of the hospital on a CMS website, releasing this information prematurely could identify hospitals that have already taken corrective actions and come into compliance after issuance of a warning letter,” a CMS spokesperson said in a statement.

The CMS is checking to ensure hospitals are 100% compliant. Violations included using code to block search engines and not including payer-specific negotiated rates with a payer’s name.

How Wipfli can help

We can help hospitals comply with these new regulations, going beyond basic reporting to helping to ensure the data reported is accurate and understandable.

Our services include:

  • Creation of a CMS compliant machine-readable all services file starting with the hospital chargemaster
  • Development of a shoppable services file to include the required 300 shoppable services packaged in a simple to use data visualization tool placed on the hospital website

Email us today to get started or check out our hospital price transparency web page for more details.

Author(s)

Jane F. Jerzak, CPA, RN
Health Care Partner
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