The Centers for Medicare & Medicaid Services (CMS) issued a new rule on hospital price transparency that went into effect January 1, 2021. Under a section of the Public Health Service Act (PHSA), hospitals are required to publish a list of standard charges each year. Originally, hospitals could fill this requirement just by publishing their chargemaster list (a comprehensive list of all products, procedures, and services provided by a hospital) online; now, however, hospitals are told exactly what they are required to publish, and how to publish it, in order to comply with the PHSA.
Hospitals must publish the following five types of charges to a machine-readable file for all “items and services” the hospital has a standard charge for:
- Gross Charges: non-discounted rate reflected in the chargemaster.
- Discounted Cash Prices: rate charged to individuals who pay cash or cash equivalent.
- Payer-Specific Negotiated Charges: rate the hospital has negotiated with a third-party payer for an item/service.
- De-Identified Minimum Negotiated Rates: lowest rate the hospital has negotiated with all third-party payers for an item/service.
- De-Identified Maximum Negotiated Rates: highest rate that the hospital has negotiated with all third-party payers for an item/service.
Additionally, a consumer-friendly list must be published with charges for the hospital’s 300 most “shoppable service” or services that can be scheduled in advance – these include things such as psychotherapy, laboratory services, pathology services, radiology, and medicine and surgery services. There are 70 shoppable services that CMS requires to be included on the consumer-friendly list, with the remaining 230 left open for the hospitals to decide.
More information on the price transparency rule can be found here: https://www.jdsupra.com/legalnews/health-care-price-transparency-cms-says-2250707/