CMS Hospital Price Transparency

Learn how to support your compliance with the federal transparency mandate and optimize your rates with PayerAnalytics.

Introduction

The CMS Hospital Price Transparency Rule mandates that hospitals publicly disclose their standard charges, including negotiated rates with payers, in both a machine-readable format and a consumer-friendly format.

While this rule might seem burdensome, it offers a unique opportunity for healthcare providers to benchmark their negotiated rates and gain a competitive edge.

PayerAnalytics streamlines the process of preparing pricing files and listings in CMS-specified formats by providing the necessary tech infrastructure to generate and manage MRF files, support for shoppable services, and valuable insights for effective rate benchmarking.

Key Deadlines and Requirements

The CMS Hospital Price Transparency Rule has specific deadlines that hospitals must meet to remain aligned with regulatory requirements. These deadlines are crucial for avoiding penalties and leveraging the rule's benefits.

  • July 1, 2024: Hospitals must conform their Machine-Readable Files (MRFs) to the CMS template layout. This includes new data elements such as gross charges, discounted cash prices, and payer-specific negotiated charges.
  • January 1, 2025: Hospitals must include additional elements in their disclosures, such as estimated allowed amounts and detailed drug information.

Additionally, hospitals must have a link to the "Price Transparency" page in the footer of their website, ensuring easy access for patients and compliance checks. Hospitals are also required to maintain a specific file in their root directory to facilitate automated retrieval of their pricing information.

PayerAnalytics provides tools that support the generation and management of MRF files, helping teams stay on track through automation and formatting support.

Compliance Checklist

  • Review and gather all standard charges and negotiated rates.
  • Format data according to CMS requirements.
  • Generate and manage Machine-Readable Files (MRFs).
  • Ensure a link to the "Price Transparency" page is present in the footer of your hospital's website.
  • Publish data in both machine-readable and consumer-friendly formats.
  • Include necessary elements such as gross charges, discounted cash prices, and payer-specific negotiated charges by July 1, 2024.
  • Include additional elements such as estimated allowed amounts and detailed drug information by January 1, 2025.
  • Regularly update and maintain your data to ensure ongoing compliance.

Penalties for Non-Compliance

Non-compliance with the CMS Hospital Price Transparency Rule can result in significant penalties:

  • Smaller hospitals (30 or fewer beds): Fined $300 per day.
  • Larger hospitals: Subject to $10 per bed per day, with a maximum of $5,500 daily, potentially totaling up to $2,007,500 per year.
  • Reputation Risk: CMS also publishes the names of non-compliant hospitals, which can harm their reputation.

PayerAnalytics supports your ongoing efforts to stay aligned with current transparency requirements.

How PayerAnalytics Can Help

PayerAnalytics supports hospitals in their efforts to comply with Hospital Price Transparency requirements by providing:

  • Automated Compliance Tools: Simplify the data formatting and publishing process.
  • Benchmarking Insights: Compare your rates with those of other providers to identify opportunities for optimization.
  • Tech Infrastructure: Generate and manage MRF files and support shoppable services.
  • Regular Updates: keep your data current and aligned with the latest CMS formatting guidance.
  • Expert Support: Access to our team of experts for guidance and assistance.

PayerAnalytics supports your organization’s efforts to align with requirements and manage potential risk, supporting your efforts to avoid penalties and maintain a strong reputation.

Example of Shoppable Service Information

See how PayerAnalytics can transform your hospital's approach to price transparency.

Similar info can be embedded on hospitals' websites using PayerAnalytics technology.

MRI of the Brain (with and without contrast)

Charge Type Price
Gross Charge $2,500
Discounted Cash Price $1,200
Payer-Specific Negotiated Charges Payer A: $1,800
Payer B: $1,950
De-Identified Minimum Negotiated Charge $1,700
De-Identified Maximum Negotiated Charge $2,100

CT Scan of the Abdomen and Pelvis (with contrast)

Charge Type Price
Gross Charge $1,800
Discounted Cash Price $900
Payer-Specific Negotiated Charges Payer A: $1,400
Payer B: $1,500
De-Identified Minimum Negotiated Charge $1,300
De-Identified Maximum Negotiated Charge $1,600

Colonoscopy (screening)

Charge Type Price
Gross Charge $3,000
Discounted Cash Price $1,500
Payer-Specific Negotiated Charges Payer A: $2,200
Payer B: $2,400
De-Identified Minimum Negotiated Charge $2,000
De-Identified Maximum Negotiated Charge $2,600

Ready to enhance your hospital's transparency and improve patient trust? Contact us to learn more about how PayerAnalytics can support your Price Transparency objectives.

Frequently Asked Questions (FAQ)

The federal Hospital Price Transparency rule requires hospitals to publicly disclose standard charges, including payer-specific negotiated rates for services. The goal is to provide patients with clearer, more accessible information about the cost of care.

Hospitals must format their Machine-Readable Files (MRFs) to align with the federal template by July 1st, 2024. By January 1st, 2025, additional disclosures are required, including estimated allowed amounts and detailed drug information.

Non-compliance may result in financial penalties. Hospitals with 30 or fewer beds may be fined $300 per day. Larger hospitals may incur $10 per bed per day, up to $5,500 daily, totaling as much as $2,007,500 annually. In addition, the names of non-compliant hospitals may be published publicly, which can impact reputation.

Benchmarking negotiated rates helps provider organizations optimize their pricing strategies, increase financial margins, and improve operational efficiency. By analyzing market comparisons, hospitals can identify opportunities to enhance revenue and streamline operations.

PayerAnalytics offers tools designed to simplify the preparation and formatting of pricing data in alignment with the federal price transparency rule. While the platform does not offer legal or regulatory advice, it supports hospitals by streamlining the creation of MRFs, assisting with shoppable services, and providing benchmarking insights using publicly available Transparency in Coverage data.

You can contact our team to schedule a demo. We'll walk you through the platform and show how it can support your organization’s price transparency efforts efficiently and effectively.

Disclaimer: The information provided on this page is for general informational purposes only. PayerAnalytics does not provide legal or regulatory advice. Use of this platform does not guarantee compliance with federal price transparency requirements. Users are responsible for ensuring the accuracy and completeness of their disclosures. This platform is not affiliated with or endorsed by CMS or any government agency.

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