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CMS Plans to Crack Down on Price Transparency Compliance in 2024

Analysis  |  By Amanda Norris  
   July 19, 2023

Price transparency adherence may become more complex in 2024.

CMS recently released the 2024 OPPS proposed rule, and among the yearly payment rate changes, CMS proposed changes to its price transparency regulations.  

In the proposed rule, CMS is requesting that hospitals be required to submit a certificate verifying the accuracy and completeness of data and acknowledge any warning notices it may receive. CMS says it may also decide to post its assessment of hospital compliance and any compliance action taken against a hospital on its website, including notifications sent to hospital leadership, if the proposed rule is finalized.

Currently, hospitals are required to make some of the 300 standard charges shoppable services by placing them in a consumer-friendly format or offering a price estimator tool patients can use to estimate out-of-pocket costs, but in the proposed rule, CMS wants to require hospitals to display standard charges data within a specific template.

CMS also proposed hospitals encode all standard charge information, including but not limited to information such as each standard charge type and expected charges in dollar amounts for items or services currently denoted as a percentage or algorithm for payer negotiated prices.

This proposed rule comes on the heels of a separate crack down that CMS announced earlier this year.

In April, the agency announced it would require corrective action plan (CAP) completion deadlines, impose civil monetary penalties earlier and automatically, and streamline the compliance process of price transparency requirements.

CMS says it conducts over 200 comprehensive reviews of hospital price transparency compliance per month, and as of April 2023, CMS has issued more than 730 warning notices and 269 CAP requests. It has also imposed civil monetary penalties on four hospitals for noncompliance.

Although CMS maintained its requirement that noncompliant hospitals submit a CAP within 45 days from the CAP request, it will now require these hospitals to be in full compliance with price transparency guidelines within 90 days from when it issued the request.

Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.

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