CMS has started price transparency compliance audits: 6 things to know

CMS has started auditing a sample of hospitals for compliance with the price transparency rule, an agency spokesperson confirmed to Becker's Hospital Review. 

Under the rule, which took effect Jan. 1, hospitals in the U.S. are required to post their standard charges online. Hospitals must post a machine-readable file with all items and services and display prices of 300 services in a consumer-friendly format. 

Here are six things to know about the audits and compliance:

1. CMS complaint form. In addition to audits, CMS is investigating complaints of noncompliance with the price transparency rule. The agency has an online form that is accessible to the public. Patients are encouraged to submit complaints if they can't find a hospital's standard charges online.

2. What happens if there's a violation. If CMS finds a hospital is noncompliant, the agency may request a corrective action plan, assess a civil monetary penalty of up to $300 per day or publicize the penalty on a CMS website. CMS said the penalty and publicization are likely if the hospital fails to respond to its request to submit a corrective action plan. 

3. There are no hardship waivers or exemptions. CMS said that hospitals can't apply for waivers or hardship exemptions. CMS said it already delayed the effective date by one year. "We believe this provided hospitals with sufficient time to collect and display the standard charge information as required under this rule," CMS said. 

4. How a price estimator tool can help compliance. CMS said it will deem a hospital as having met the requirement of posting a consumer-friendly list of standard charges if the hospital has an online price estimator tool that provides out-of-pocket cost estimates in real time. 

5. Appeals of civil penalties. Hospitals can appeal a monetary penalty imposed by CMS. The hospital can request a hearing before an administrative law judge. The hospital has 30 calendar days after the penalty is imposed to appeal.

6. Results of the audits. CMS declined to say whether the sample of hospitals in the audit have met compliance or have faced civil penalties. "To ensure the sanctity of this review process — especially in the early days following hospital price transparency requirements taking effect on Jan. 1, 2021 — CMS looks forward to providing additional information as appropriate and as it becomes available in the future," a CMS spokesperson told Becker's Hospital Review.

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