Price transparency is here to stay: CMS sends out compliance warning letters

The Centers for Medicare and Medicaid Services have started sending warning letters to hospitals that have yet to comply with the price transparency rule, a clear indication that the agency’s compliance efforts will likely increase in the months to come up.

The rule, which took effect on January 1, is designed to help consumers and shoppers purchase health care services more efficiently. It requires hospitals to publish a variety of pricing information, including discounted spot prices, payer-specific negotiated prices, minimum and maximum negotiated rates, and prices for 300 health services that can be purchased.

A recent study found that 65 of the 100 hospitals sampled had broken the rule. CMS began sending warning letters in April to hospitals that had yet to publish their prices, according to published reports. Once a letter of non-compliance is received, hospitals have 90 days to resolve the issue. If hospitals don’t follow the rule, CMS could fine them $ 300 per day and/or make the fine public. Some congressional leaders are calling on CMS to step up compliance audits and review the amount of the fine in light of widespread non-compliance.

Change Healthcare sees the transparency mandate as an opportunity for hospitals to accelerate the development of their digital consumption strategy while building patient confidence. Our Settlement Estimator Patient Direct and Shop Book and Pay ™ solutions to enable consumers to receive accurate estimates of out-of-pocket spending at the point of service or sooner. We can help you comply with price transparency regulations as part of a larger strategy to create a complete retail-style healthcare shopping experience.