Four hospitals were hit with major fines for not adhering to the regulation.
CMS is once again cracking down on enforcement of the price transparency rule through monetary penalties.
For noncompliant hospitals, the agency recently announced will now require corrective action plan (CAP) completion deadlines, impose civil monetary penalties earlier and automatically, and streamline the compliance process.
CMS says it conducts over 200 comprehensive reviews of hospital price transparency compliance per month, and as of April 2023, CMS has issued more than 730 warning notices and 269 CAP requests. It has also imposed civil monetary penalties on four hospitals for noncompliance.
According to CMS, the hospitals fined are:
- Northside Hospital Atlanta in Georgia, fined $883,180
- Northside Hospital Cherokee in Georgia, fined $214,320
- Frisbie Memorial Hospital in New Hampshire, fined $102,660
- Kell West Regional Hospital in Texas, fined $1127,260
Although CMS maintained its requirement that noncompliant hospitals submit a CAP within 45 days from the CAP request, it will now require these hospitals to be in full compliance with price transparency guidelines within 90 days from when it issued the request.
Previously, hospitals were allowed to propose their own completion date for CMS approval.
The No Surprises Act, which became effective last year, requires hospitals to post the prices for their most common procedures as well as offer a patient-friendly tool to help shop for 300 common services.
Unfortunately, there are still organizations are behind in adhering to this requirement.
According to the recent PatientsRightsAdvocate.org's Semi-Annual Hospital Price Transparency Report, only 16% of 2,000 hospitals reviewed are complying with the regulation requiring all hospitals to post their charges, including payer-specific negotiated rates.
Of the hospitals studied, 5.1% were in total noncompliance as they did not post any standard charges file, and 51.3% failed compliance because the majority of their pricing data was missing or incomplete.
While some organizations now have systems in place to help them adhere to the new rules, opportunities still exist to revisit outdated revenue cycle processes to better comply with these regulations.
Connie Lockhart, director of strategy and operations at Impact Advisors, previously discussed with Healthleaders some key strategies that revenue cycle leaders can use to increase price transparency compliance. When first shoring up price transparency processes (and as mentioned in the studies above), there are two main requirements that organizations need to adhere to immediately.
"Revenue cycle leaders need to first make sure they are following CMS' guidelines to complete a comprehensive, machine-readable file of all services and items," she says. "Ensure all requirements are met—like how a separate file must be posted for each hospital. And be cognizant of multiple hospitals operating under a single hospital license with different sets of standard charges."
Also, ensure that list is posted on a publicly available website.
Once completed, make sure to post a display in a publicly available website of 300 shoppable services in a consumer-friendly format. This should include the 70 CMS-specified, shoppable services, Lockhart says. Revenue cycle leaders should also establish a cadence to ensure both displays are updated annually, Lockhart says.
Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.
As of April 2023, CMS has issued more than 730 warning notices, 269 CAP requests, and imposed civil monetary penalties on four hospitals.
To avoid fines, revenue cycle leaders need to first make sure they are following CMS' guidelines to complete a comprehensive, machine-readable file of all services and items.