CMS says it will audit some hospitals in January for compliance with price transparency rule

The Centers for Medicare & Medicaid Services said today that will audit a sample of hospitals in January for compliance with the agency’s hospital price transparency rule that takes effect Jan. 1, 2021.

The AHA is challenging the rule in court. Earlier this year, the AHA and other national associations asked the Department of Health and Human Services to delay the implementation date of the rule due to the burden it would represent for hospitals and health systems in the midst of responding to the COVID-19 public health emergency until the matter is settled by the courts.

AHA this month urged President-elect Biden in his first 100 days in office to rescind provider requirements to publicly disclose negotiated rates that do nothing to help patients understand their costs, could result in anticompetitive actions on the part of health plans, and, according to the Federal Trade Commission, could result in high costs for patients.

The rule requires hospitals and health systems to disclose all standard charges, as defined by CMS to mean privately negotiated rates with insurers, gross charges (also known as list prices) and discounted cash prices. Hospitals also will be required to provide an out-of-pocket price estimator tool or negotiated rate information on 300 “shoppable” services for patients.

Visit AHA’s webpage for more on the rule and AHA’s resources.