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CMS plans aggressive action to achieve more price transparency


By law, hospitals have been required to make public their prices for goods and services since Jan. 1, 2021, but not all are complying

Hospital price transparency is the law of the land, but not all hospitals are complying. CMS said that it will take aggressive steps to identify hospitals lacking the mandated price information on their websites, according to a blogpost in Health Affairs. These charges should include gross charges, discounted cash prices, payer-specific charges, and minimum and maximum negotiated charges. CMS requirements state this information should be presented in a consumer friendly manner with at least 300 services and in a machine-readable file.

CMS is upping its enforcement after a randomly selected group of hospitals fared poorly in complying with the requirement in 2021. Less than a third of the surveyed group followed the guidelines, while 66% met the consumer-friendly criteria, and 30% posted a machine-readable file. As a result, the penalty for noncompliance was increased from $100,000 to more than $2 million per hospital annually. Compliance increased significantly in 2022, with 70% of a sample of hospitals meeting both the consumer and file-type criteria.

According to CMS, the agency issued nearly 500 warning letters in 2022 and more than 230 requests for corrective action plans. Two hospitals received penalties for noncompliance.

This year, CMS is vowing more action. Hospitals are expected to face stricter enforcement efforts that may include expediting the timeframes by which it requires hospitals to come into full compliance upon submitting a correction action plan. The agency says it will more aggressively identify hospitals with deficiencies and prioritize action against those that have failed to post files at all.

In addition, CMS said it would aim for more standardization to help hospitals comply with the rules and help third parties make prices more easily available to consumers. It is also considering implementing rules on where the link to the information must be on the hospital’s website.

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