CMS Unveils Aggressive Price Transparency Enforcement Tactics

Hospital Pricing Specialists

Yesterday, the Centers for Medicare and Medicaid Services (CMS) unleashed a menacing announcement that should send shivers down the spine of any hospital not complying with price transparency regulations. CMS is cracking down on non-compliance like never before with a series of new updates that will have dire consequences for the non-compliant:

1.  Hospitals that have dared to ignore price transparency regulations will be targeted without mercy. CMS will skip the usual warning and go straight for the jugular by demanding an immediate corrective action plan (CAP).

CMS will apply a standard audit of the hospital’s machine-readable files, comparing any Medicare volumes among the 70-defined shoppable codes (e.g., DRG 470) to what a hospital posts in its MRF.  For example, CMS will determine if a hospital has Medicare volumes for a hip/knee replacement (DRG 470) and then check to see if negotiated rates for this DRG are in the MRF.

2.  There will be no time for negotiation or excuses. Hospitals will be given just 90 days to get their act together and comply with the regulations, as opposed to being allowed to propose a compliance date in their CAP.

3.  CMS will not tolerate any hospital that dares to flout the rules. If a hospital fails to submit a CAP on time, it will be hit with heavy civil monetary penalties. And if the hospital does submit a CAP but still doesn’t comply within the 90-day deadline, the punishment will be even more severe.

Hospitals, beware. CMS means business, and failure to comply will lead to disastrous consequences that could ruin your reputation and bottom line.

If you need help with price transparency compliance, you can look no further than HPS.  We’re the industry’s recognized leader in providing 100% compliant price transparency services. 

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