Report on Medicare Compliance 30, no. 28 (August 2, 2021)
◆ CMS has not fined any hospitals yet for noncompliance with price transparency requirements, a spokesperson tells RMC. “In April 2021, CMS began issuing warning letters to hospitals not in compliance with requirements of the Hospital Price Transparency final rule. Upon receipt of a warning letter for noncompliance, hospitals have 90 days to address the findings cited in the warning letter. CMS will rereview upon expiration of the 90-day window, or earlier if a hospital alerts CMS that the finding(s) of noncompliance has been addressed,” the spokesperson said. “Should CMS conclude a hospital is noncompliant with one or more of the requirements to make public standard charges, CMS may take any of the following actions, which generally, but not necessarily, will occur in the following order: (1) Provide a written warning notice to the hospital of the specific violation(s); (2) Request a corrective action plan from the hospital if its noncompliance constitutes a material violation of one or more requirements; and (3) Impose a civil monetary penalty, not in excess of $300 per day, on the hospital and publicize the penalty on a CMS website if the hospital fails to respond to CMS’s request to submit a corrective action plan or comply with the requirements of a corrective action plan.” Meanwhile, in the proposed outpatient prospective payment system regulation announced July 19, CMS said it would increase the penalties for hospital noncompliance with the price transparency requirement.[1]
◆ CMS’s supplemental medical review contractor said July 26 it’s auditing claims for carotid artery screening/testing with 2019 dates of service.[2]
1 Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals To Make Standard Charges Public, 84 Fed. Reg. 65,524 (November 27, 2019), https://bit.ly/3rsTZhw.
2 “01-054 Carotid Artery Screening/Testing Notification of Medical Review,” Noridian Healthcare Solutions, last updated July 26, 2021, https://bit.ly/3yjIThP.
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