Dear Colleague,
In the labyrinth of healthcare regulations, the transparency of hospital pricing remains a hot-button issue. A recent report to the U.S. House Committee on Energy and Commerce by the Government Accountability Office (GAO) underscores a critical challenge: the Centers for Medicare and Medicaid Services (CMS) are currently unable to verify the accuracy and completeness of hospital pricing data. This revelation is more than a bureaucratic footnote; it signals potential upheaval for hospitals across the nation.
The First Step: Data Verification
The first crucial step in ensuring compliance with CMS mandates involves hospitals publishing their pricing data in the correct, CMS-approved format. This is not just about meeting a requirement but ensuring that the data is accessible and usable for both CMS and the public. This includes the proper creation and placement of the cms-hpt.txt file.
The Next Step: Data Comparison
Once the data is published, the next phase is critical: comparison against adjudicated claims. CMS plans to scrutinize how well the published data matches up with actual claims data to ensure that both gross charges and cash prices reflect reality. This comparison is not trivial—it is a foundational check that impacts how hospitals will be perceived and reimbursed.
Why Proactivity Matters
With the GAO’s findings and the impending CMS audits, hospitals have a clear mandate to get ahead of the curve. This is not merely about compliance, but about demonstrating accountability and transparency in an industry often criticized for its opacity. The proactive audit analysis offered by Hospital Pricing Specialists taps directly into CMS’s own claims database, providing hospitals with a preemptive evaluation of how their data stands up to CMS scrutiny.
Ensuring Compliance Through Expertise
HPS is poised to assist hospitals in navigating these complexities. With the ability to create 100% compliant machine-readable files, our services are designed to align with the most current standards, including the upcoming January 1, 2025 updates. These updates will mandate the inclusion of detailed modifiers and drug codes, adding another layer of complexity to compliance efforts.
If you are interested in a complimentary machine-readable file claims audit, or just want to chat, here is my calendar link: go.oncehub.com/ricklouie
Best regards,
