CMS begins Price Transparency Compliance Audits – How does Your Institution Measure Up?

CMS has begun auditing hospitals to ensure compliance with Hospital Price Transparency requirements. The requirements went into effect on January 1, 2021. Now is the time to ensure that your institution’s marketing efforts will stand up to federal scrutiny.

Under the requirements, hospitals must post their specific charge information online in a machine-readable format. The prices of 300 services must be displayed in a consumer-friendly format. CMS is pursuing an auditing sample of hospital providers to ensure compliance with the rule. In the final rule, CMS extensively outlined a monitoring and enforcement plan to ensure hospital compliance with the requirements. Under the plan, CMS will begin by auditing hospital websites.

CMS will also investigate complaints submitted through a form available to the public online. The complaint form asks for the hospital’s website and contact information, a description of the complainant’s concerns, specific information about how required information was unable to be located, details on any correspondence with the hospital, and supporting digital evidence of concerns cited in the complaint. Complaints can be filed anonymously.

Noncompliance with the Hospital Price Transparency requirements prompts a host of potential violations, including written warning notices, requests of corrective action plans, and even civil monetary penalties up to $300 a day. A corrective action plan requested by CMS must include the process the hospital will undergo to correct deficiencies identified by CMS, and a timeframe during which the corrective action must be completed. CMS may also publicize penalties in the event the hospital fails to respond to requests for corrective action plans or comply with requirements.

CMS is not offering any waivers or extensions for compliance with the Hospital Price Transparency requirements, citing that enforcement was already delayed by a year. In the event a hospital is found to be noncompliant with the requirements, the hospital will have a chance to appeal. The Final Rule provides hospitals with 30 days to appeal after a monetary penalty is imposed. Hospitals will have 60 days to pay the civil penalty from either the date the penalty is imposed, or from the date a final, binding decision is entered on appeal by an ALJ.

Advis is available to conduct mock CMS audits of your price transparency compliance practices to ensure alignment with these new regulations. Please contact us at (708) 478-7030 for more information.

Published: January 21, 2021