CMS again updates hospital price transparency requirement

Posted on: 12/12/18

Last week the Centers for Medicare and Medicaid Services (CMS) posted an additional FAQ document on their guidance for hospitals to post “standard charges” on the internet in machine readable form, effective January 2019. To view the new document, click here.

Some hospitals have told CMS that their hospital chargemaster does not contain charge information for drugs, because this price information comes from a pharmacy module or application. The new CMS document states that even if the hospital’s chargemaster lacks standard charges for drugs, biologicals, or other items and services provided by the hospital, those standard charges must be included in the list posted on the internet.

CMS also reminded hospitals that the law (ACA) requires each hospital to “make public a list of their standard charges for each diagnosis-related group,” and specifies that this DRG requirement applies only to subsection (d) hospitals: those paid under Medicare’s Inpatient Prospective Payment System.  It is unclear if CMS expects this DRG information to be, like the itemized detail charge information, posted on the internet in machine-readable form.

A CMS FAQ from late September, did not include any guidance on posting DRG-based “standard charge” information. The new FAQ says hospitals may, but are not required to, use a format CMS utilized for reporting hospital charges by DRG, in which the average amount billed to Medicare by the hospital was reported for each DRG. Data was suppressed for DRGs when the average represented 10 or fewer discharges for the DRG in a particular year. (Rick Snyder)