CMS Will Finalize Heightened Penalties, Additional Requirements Under Hospital Price Transparency Rule

On November 2, 2021, the Facilities for Medicare and Medicaid Providers (CMS) introduced that it’ll implement elevated penalties for hospitals that don’t adjust to the Hospital Price Transparency Rule, efficient January 1, 2022. CMS can even finalize a number of further necessities for hospitals, together with a requirement that hospitals guarantee customary cost data is accessible to automated searches and direct downloads.

CMS will implement a sliding penalty scale primarily based on the hospital’s variety of beds. Hospitals with 30 or fewer beds will face a most each day penalty of $300, whereas hospitals with between 31 and 550 beds will face a most each day penalty of $10 per mattress. Hospitals with greater than 550 beds will face a most each day penalty of $5,500.

CMS can even require hospitals to make sure that their customary cost data is well accessible, with out limitations, together with however not restricted to making sure that the knowledge is accessible to automated searches and direct file downloads by means of a hyperlink posted on a publicly obtainable web site. This requirement will prohibit a single hospital from utilizing a number of machine-readable recordsdata, utilizing “blocking codes” or CAPTCHA, or requiring customers to comply with phrases and situations or submit different data previous to entry.

CMS additionally clarified that worth estimator instruments should enable healthcare shoppers, on the time they use the device, to acquire an estimate of the quantity they are going to be obligated to pay the hospital for a shoppable service. Such estimator instruments have to be “tailored to individuals’ circumstances (whether an individual is paying out of pocket or using insurance) and provide real-time individualized out of pocket estimates that combine hospital standard charge information with the individual’s benefit information . . . or provide the self-pay amount.” The estimated quantity have to be “personalized” and replicate a single out-of-pocket greenback quantity. An estimated vary, by itself, wouldn’t meet the regulation’s necessities.

For extra data on these proposed adjustments, click here.

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