As many are aware, compliance with price transparency requirements continues to lag. Under the final rule, effective January 1, 2021, hospitals are required to provide clear, accessible pricing information online about the items and services they provide in two ways: as a comprehensive machine-readable file with all items and services and via a display of shoppable services in a consumer-friendly format. This information is intended to make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital. As of last fall, less than two-thirds of hospitals were meeting all transparency requirements. CMS has been auditing hospitals which has resulted in monetary penalties for some of them.

Compliance with price transparency requirements adds to the workload hospital administrations have faced for years. In an effort to provide support, CMS offers online resources, including samples of machine-readable formats and quick guides for hospitals to use as a reference for what they ultimately post. CMS aims to achieve higher compliance numbers and recently indicated it plans to do so by updating its enforcement process. CMS has also indicated it will continue to require corrective action plans but will require hospitals to comply with the plan within 90 days rather than permitting the hospital to set a timeframe for completion. It will also impose penalties on those who fail to provide a plan to correct errors.

Whether price transparency requirements help patients to better navigate the cost of care remains to be seen, CMS expects hospitals to comply with the rules and will step up its efforts to ensure compliance. Our attorneys have assisted clients who receive warning letters from CMS and have provided guidance in submitting corrective action plans.