Hospital Price Transparency Preparation and Court Challenges are in Full Swing.

Even with the extended effective date of January 1, 2021, hospitals are feeling the pressure of meeting the hospital price transparency requirements finalized this past November. Suddenly, that January date is not so far off. Monetary penalties for non-compliance are up to $300 a day. Take a look now. Please.

The holiday, end of the year chaos may have caused hospitals to miss CMS’s announcement that 70 mandatory shoppable services must be included in the hospital’s list of 300 shoppable services. CMS has also conducted some MLN events in the meantime that provide some guidance to providers seeking clarification on the final rule. As anticipated, while CMS launched MLN matter sessions, four healthcare associations, including the AHA (American Hospital Association) and FHA (Federation of American Hospitals), and three hospitals, filed a lawsuit against HHS over the hospital price transparency requirement that mandates the disclosure of payer-specific negotiated rates.

Advis has created this quick snap shot of the CMS guidance that includes for your convenience the CMS required 70 shoppable services.

The following guidance was provided by CMS during an MLN Matters Session on December 2, 2019 (must click on Presentation).

Here are the highlights from the presentation:

Two Required Ways for Making Public Standard Charges

Hospitals must make public their standard charges in two ways:

1) Comprehensive Machine-Readable File

  •  A single machine-readable file that contains all five types of standard charges for all the items and services provided by the hospital
  • Based on public comment, we (CMS) believe this information and format is most directly useful for employers, providers, and tool developers who could use these data in consumer-friendly price transparency tools or who may integrate the data into electronic medical records and shared decision making tools at the point of care; and

2) Consumer-Friendly Shoppable Services

  • A consumer-friendly list of some types of standard charges for a limited set of “shoppable services” (including 70 CMS-specified and 230 hospital-selected services) provided by the hospital
  • A ‘shoppable service’ is a service that can be scheduled by a health care consumer in advance
  • We believe these requirements will allow health care consumers to directly make apples-to apples comparisons of common shoppable hospital services across health care settings.

Requirements for Making Public All Standard Charges for All Items and Services in a Machine-Readable Format

  • Each hospital location operating under a single hospital license that has a different set of standard charges must separately make public the standard charges that are applicable to that location.
  • Required Data Elements:All standard charges (gross charges, payer-specific negotiated charges, discounted cash prices, minimum and maximum negotiated charges) that apply to each item or service when provided, as applicable, in the hospital inpatient and outpatient department setting; and
  • Any code used by the hospital for purposes of accounting or billing for the item or service, for example, HCPCS codes, DRG codes, or other common payer identifier.Here is an example provided by CMS:

CMS Sample Display of Shoppable Services for Consumers

Final List of 70 CMS-Specified Shoppable Services

Although, we have not heard how the structure and timeline will be for the monitoring of hospital compliance, CMS closed their presentation with a reminder that audits and monitoring of hospital compliance will be exercised with monetary penalties of up to $300 a day. Advis is available to assist you with this process as well as address any questions you may have regarding the implementation of this new process.

Published: February 27, 2020