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OIG Plans to Keep an Eye on CMS' Price Transparency Enforcement

Analysis  |  By Amanda Norris  
   October 25, 2022

Health systems are not the only entities now being held accountable for upholding price transparency.

The OIG recently announced it will be assessing CMS' monitoring and enforcement of the hospital price transparency rule. This audit, the OIG says, is expected to be released next year.

"We will review the controls in place at CMS and statistically sample hospitals to determine whether CMS' controls are sufficient to ensure that hospital pricing information is readily available to patients as required by federal law," said the OIG.

The OIG will also evaluate the extent to which CMS enforces the rule. CMS previously said hospitals in noncompliance with one or more of the rule's requirements may receive a written warning notice, a request for a corrective action plan, and civil monetary penalties (CMP).

In June, CMS issued its first CMPs for violating the hospital price transparency rule to two Georgia hospitals in the same health system. The hospitals were collectively fined approximately $1.1 million after they failed to respond to notices and provide corrective action plans.

The clock started in January of 2021 when the first of three different rules and laws that dictate price transparency went into effect.

Adherence to the regulation has been off to a slow start as many organizations site administrative burdens and revenue cycle workforce shortages as the cause to slow adoption.

"If hospitals are not in compliance with CMS' rule for listing their charges, we will contact the hospitals to determine the reason for noncompliance and determine whether CMS identified the noncompliance and imposed consequences on the hospitals," said the OIG on its upcoming audit.

When first shoring up price transparency processes, there are two main requirements that organizations need to adhere to immediately, Connie Lockhart, director of strategy and operations at Impact Advisors, previously shared with HealthLeaders.

"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.

“If hospitals are not in compliance with CMS' rule for listing their charges, we will contact the hospitals to determine the reason for noncompliance and determine whether CMS identified the noncompliance and imposed consequences on the hospitals.”

Amanda Norris is the Revenue Cycle Editor for HealthLeaders.


KEY TAKEAWAYS

The OIG says it will be auditing CMS' enforcement of the price transparency law, meaning CMS is likely to crack down on noncompliance.

When first shoring up price transparency processes, there are two main requirements that organizations need to adhere to immediately.

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