On August 14th, CMS hosted a Q&A session regarding the new OPPS and ASC Proposed Rule. Once again, CMS was unable to provide clear guidance for hospitals pertaining to price transparency requirements and compliance. As Advis previously noted in our original post summarizing the proposed rule, the CMS price transparency requirements remain anything but transparent.

On the call, hospital participants asked for clarification on key matters of concern. Rather than answer a direct question with a direct answer, CMS requested that instead providers submit questions in writing through the comment process. Participants pushed back against CMS’ estimation of the time and money necessary to implement the requirement. CMS gave no indication that it plans to delay the new rule’s January 1, 2020 effective date.

Examples of questions that CMS could/would not answer during the Q&A, but suggested would be addressed if submitted as comments, include:

  1. How does CMS define “charge” and “rate”; how does CMS distinguish between the two terms?
  2. What should hospitals do if their payer contracts do not allow disclosure of negotiated charges or rates?
  3. How should the machine readable and consumer friendly “shoppable services” lists be formatted?
  4. How does CMS define “customary” charges?
  5. How should hospitals that do not have 300 “shoppable services” comply with the requirement?

The deadline for submitting questions aimed at clarity regarding the nuances of the requirement is September 27, 2019.

Advis recommends that hospitals prepare now for the price transparency requirement by gathering and organizing payer contracts and rate sheets, as it will very likely take longer than CMS is anticipating to implement compliant solutions.

Hospitals that would like assistance in designing strategies to meet the proposed transparency requirements or in drafting comments to CMS, should contact Advis at (708) 478-7030.