Hospitals question CMS price transparency rule

Posted on: 10/3/18

In the Medicare Inpatient final rule for 2019, the Centers for Medicare & Medicaid Services (CMS) added a little detail to a confusing requirement for hospital price transparency. The Affordable Care Act included a requirement for hospitals to make public “the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups.”  

Earlier guidance from CMS was not very specific, stating only that hospitals are required to either make public a list of their “standard charges (whether that be the chargemaster itself or in another form of their choice) or their policies for allowing the public to view a list of those charges in response to an inquiry.”

Effective Jan. 1, 2019, CMS more specifically requires hospitals to “make available a list of their current standard charges via the internet in a machine readable format and to update this information at least annually, or more often as appropriate. This could be in the form of the chargemaster itself or another form of the hospital’s choice, as long as the information is in machine readable format.”

OHA’s Rick Snyder and representatives from other state hospital associations last week discussed the change with a leader in the CMS Hospital and Ambulatory Policy Group responsible for this rule. It appears that CMS interprets “standard charges” to mean simply “chargemaster,” rather than any summarized information such as by diagnostic related group, at this time. CMS sees DRG-level reporting of charges by hospitals as adding value, but not as a substitute for providing a complete list of standard charges in machine readable format on the internet.

The rule does not include any requirement to include standard revenue codes or procedure codes as part of the list.

On Sep. 27, CMS published “Frequently Asked Questions Regarding Requirements for Hospitals To Make Public a List of Their Standard Charges via the Internet.” The new FAQ document states that the requirement applies to all hospitals, with no exceptions; and to all items and services provided by the hospital. Hospitals are encouraged to supplement the information with “consumer friendly information.”

Snyder and others have asked CMS to answer questions from hospitals on these price transparency requirements in a Hospital Open-Door Forum conference call, allowing time for implementation by Jan. 1, 2019.