Four Tips to Prepare for CMS Price Transparency Final Rule

As most hospital leaders know, the new CMS Price Transparency Final Rule requiring hospitals to disclose the rates they negotiate with insurers has been challenged in court. Four hospital associations and three independent hospitals are suing Health and Human Services (HSS), which oversees CMS, over the Final Rule’s statutory basis.

 Editor's Note: This article originally posted on Community Hospital Corporation's website.

 As the case wends its way through the legal system, hospitals are advised to go ahead with preparations for complying with the rule, which is set to take effect Jan. 1, 2021.

To recap, CMS’ Final Rule requires hospitals to post their “standard charges” online. Standard charges, as defined by CMS, include:

  • Gross charges
  • Discounted cash prices
  • Payer-specific negotiated charges
  • De-identified minimum negotiated charges
  • De-identified maximum negotiated charges

The rule also mandates publishing pricing information for 300 “shoppable services.”

In the previous mandate, effective Jan. 1, 2019 hospitals had been required to disclose standard charges but not payer-specific negotiated charges.

Hospitals will need to expend substantial resources to comply. For every single chargemaster item, the five different fields of “standard charges” must be completed for each payer and for each payer’s various plans. It’s a labor-intensive process that many hospitals may end up outsourcing. Click here to continue>>

 

 

 

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