CMS considers hospital price, data transparency changes in 2024

CMS proposed changing the hospital price transparency regulations to make them more accessible to patients and more strictly enforce compliance for 2024.

Within the 2024 Hospital Outpatient Prospective Payment System proposed policy changes, released July 13, CMS reiterated its authority under the CY 2020 final rule to monitor and enforce hospital price transparency regulations implemented as part of the Public Health Services Act requiring hospitals to publicly post standard charges for 300 most common services, beginning in 2021.

Last fall, CMS conducted a website assessment and found 70 percent of hospitals fully met display criteria for posting machine-readable files online and 27 percent partially met the requirements. Three percent of hospitals failed to post a machine readable file online. The agency also increased the maximum penalty for noncompliance from $100,000 to $2 million.

In April, CMS said it would require noncompliant hospitals to complete a corrective action plan with deadlines and impose civil monetary penalties for hospitals that do not meet those deadlines. CMS also eliminated warning notices for hospitals that have not attempted to meet price transparency requirements.

Hospitals are now required to make some of the 300 standard charges "shoppable services" by placing them in a consumer-friendly format or offering a price estimator tool patients can use to estimate out-of-pocket costs.

As part of the 2024 final rule, CMS pitched requiring hospitals to display standard charges data with a CMS template, which would be offered in multiple formats similar to currently available templates on the agency's price transparency website. CMS also proposed hospitals encode all standard charge information, including:

1. The name, license number and location of hospitals where patients can obtain services.

2. Each standard charge type, and expected charges in dollar amounts for items or services currently denoted as a percentage or algorithm for payer negotiated prices.

3. A description of items or services for standard charges, including information about whether services are inpatient or outpatient.

4. Codes used for accounting or billing purposes such as modifiers.

If these changes are solidified in the 2024 final rule, hospitals would have until March 1, 2024, to comply. CMS also proposed requiring hospitals to submit a certificate verifying the accuracy and completeness of data, and acknowledge any warning notices received. Finally, the agency may decide to post its assessment of hospital compliance and any compliance action taken against the hospital on its website, including notifications sent to hospital leadership, if the proposed rule is finalized.

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