News: CMS planning price transparency compliance audits, hospitals pushing back

This month, CMS begins auditing a sample of hospitals for compliance with price transparency rule. The rule, effective January 1, 2021, requires all United States hospitals to provide publicly available charge information about services offered. While there has been much pushback from hospitals for the rule thus far, CMS still urges hospitals to comply with the price transparency rule.

Hospitals found to be non-compliant will receive a written warning regarding specific violations and be expected to submit a correction plan to CMS. Violations include failing to make standard charges public in the manner required by the price transparency rule and providing the information in a patient-friendly format on the hospital website.

CMS also stated that it then will impose a civil monetary penalty of up to $300 per day, as well as make public on the agency website which hospitals have not responded to requests for compliance or have not provided a plan to correct violations. Hospitals receiving the civil monetary penalty will be required to pay CMS in full within 60 calendar days. Hospitals will be allowed to appeal civil monetary penalties, but an appeal must be submitted within 30 days of the issuance of the initial notice.

Although CMS plans to enforce the price transparency rule and begin audits this month, hospitals groups are still pushing back. The American Hospital Association (AHA) along with other similar organizations have submitted an emergency stay of enforcement motion in December, 2020. The emergency stay asks for a temporary pause of audits and fines related to the price transparency rule so that providers and hospitals can focus on COVID-19 response efforts as cases across the country growing in number and severity.

Editor’s note: CMS’ plan to audit hospitals not complying with the price transparency rule can be found here. The AHA emergency stay of enforcement motion can be found here. To read more ACDIS coverage of the price transparency ruling, click here.