The CMS’s final Hospital Price Transparency Rule officially took effect on January 1, but as of February, fully 40 percent of hospitals weren’t compliant with the rule’s requirement to publish prices in a consumer-friendly format, and 52 percent weren’t compliant with the machine-readable format requirement, per consultancy firm Guidehouse.
That’s not good for hospitals. In April, CMS launched enforcement efforts, and in July, the Biden Administration proposed increasing non-compliance penalties for large hospitals (those with 30 or more beds). If that proposal becomes law, large hospitals could face as much as $2 million in yearly penalties, up sharply from the $109,500 yearly maximum currently on the books.
For hospitals, the stakes for complying are higher than ever. But compliance itself remains challenging. Here, we highlight seven resources that can help hospitals get into compliance with the Hospital Price Transparency Rule.
1: A Step-by-Step Guide for Making Standard Charges Public
The CMS published a 10-step guide hospitals can follow to publish their standard charges in a consumer-friendly format. This guide is extremely detailed and worth reviewing for any hospital that hasn’t yet published its pricing data.
At a very high level, the 10 steps this guide outlines are as follows:
- Understand exactly what the rule requires. The guide includes definitions for all relevant terms.
- Determine which of the 70 shoppable services CMS requires hospitals to include that you provide. (Note: the guide lists all 70, along with their primary codes.)
- Identify ancillary services associated with each shoppable service. (As explained in the guide, ancillary services are those that hospitals provide along with shoppable services – e.g., the anesthesia that accompanies a colonoscopy.)
- Choose additional shoppable services. Each hospital must publish pricing information for 300 such services, or for all their shoppable services, if they offer fewer than 300. In most cases, per the CMS, hospitals will choose an additional 230 shoppable services and include their prices as outlined by the rule.
- Gather the required data for each service (i.e., the various prices. Note that prices should include what ancillary services cost).
- Choose a consumer-friendly format. This is a requirement CMS has left open-ended: hospitals can choose to publish data in any consumer-friendly format that meets CMS guidelines. Of note: whichever format you choose, the data must be searchable by billing code, service description, and payer.
- Verify that your data is searchable as described above.
- Publish the pricing information prominently on a publicly available website, free of charge. (Note: hospitals must also publish data in a machine-readable format; these steps refer only to the consumer-friendly version.)
- Update the information annually.
- Verify that you’ve met the requirements.
Detailed though this guide is, it’s possible that you’ll still have questions after reading it. If that’s the case, the next resource is worth reviewing.
2: FAQs for the Hospital Price Transparency Rule
This 21-page document, also published by CMS, highlights common questions and offers detailed answers about the Hospital Price Transparency Rule.
The questions are divided into four sections: general provisions, public disclosure requirements, monitoring and penalties for noncompliance, and appeals of civil monetary penalties.
In addition to providing detailed answers to common questions, this resource links to several other sources that offer more in-depth information.
3: Text of the Final Rule
The full text of the final Hospital Price Transparency Rule is available from the Federal Register.
Your legal and contracts teams likely already have this on their radar, but if they don’t, now’s a good time to get it there.
What’s more, the language of the rule may be useful in contract development if you choose to work with a third-party software development firm to create a customer-friendly version of your data.
4: A List of Companies that Develop Apps for the Healthcare Industry
The CMS’s 10-step guide for creating the consumer-friendly version of your pricing data notes that one option for compliance is to create a price estimator tool (as long as that tool meets the established guidelines).
A price estimator tool can help you not only comply with a portion of the the letter of the Hospital Price Transparency Rule, but also with its spirit, which is to improve price transparency in the healthcare system.
If you don’t have the resources to develop such a tool in house, of course, you’ll have to work with a third-party company. Mobile App Daily compiled a list of top development companies with experience in the healthcare industry.
While we can’t independently endorse any of the companies listed here, we consider it a good starting point for any hospital looking for developers familiar with the unique needs of their industry. For further research, consider the software comparison site G2.
5: The CMS’s Hospital Price Transparency Webcast
In December 2020, CMS offered an informational webinar about complying with the Hospital Price Transparency Rule. That webinar is now available to download. You can also download a transcript of the event and the deck the presenters used.
6: State Hospital and Healthcare Associations
State hospital and healthcare associations may also offer resources to help hospitals comply with the Hospital Price Transparency Rule. Michigan, for example, held a webinar on compliance, the recording of which is now available.
State-level resources may be especially useful, as they may offer insight into how the CMS rule overlaps or intersects with existing state-level rules and guidance.
7: The Healthcare Data Analytics Pricing Transparency Tool
If your hospital has already published its pricing data, you need a system for verifying that the data is accurate and up to date. This will ensure that you both comply with the CMS requirements and prove continued and ongoing compliance.
Our pricing transparency tool can help you do that, currently free of charge. We’re compiling pricing data from hospitals around the country, and you can use our platform to check whether the prices you’ve published on your site are accurate and how you measure up against the CMS requirements.
Get in touch with us to get access to your data so you can ensure you’re in compliance and reporting accurate numbers.
Still Not Sure How to Comply? We Can Help
If you’re still not sure how your hospital will comply with the requirements of the Hospital Price Transparency Rule, we can help.
As we gather, standardize, and monitor pricing data from thousands of US hospitals, we’re learning a lot about what works and what doesn’t. If you’d like to speak with our consultants about the best practices we have seen for posting your data, and/or how your organization can get into compliance, please reach out. We’d be happy to offer our insight to help you avoid potentially costly penalties.
And if you’re confident about the compliance and accuracy of your data, we can help you understand what prices your competitors have negotiated with payers. Our pricing transparency tool makes it possible for you to view and analyze your competitors’ data to guide your strategic decision making.
See one example of what’s possible with access to our analytics tool.