https://zeatool.com

The Centers for Medicare & Medicaid Services (CMS) issued a Price Transparency Mandate, which requires six thousand hospitals in the US to publish their chargemaster prices in a machine-readable format and 300 shoppable services in a consumer-friendly manner on their websites by January 1, 2021. The requirement is the first step to taking complex healthcare pricing information and making it transparent. 

According to CMS, the machine-readable file should include the following: 1) Comprehensive file with all items, services, and service packages which include:

  • Gross charges 
  • Discounted cash prices
  • Payer-specific negotiated charges
  • De-identified minimum negotiated charges
  • De-identified maximum negotiated charges

2)A consumer-friendly standard charges for at least 300 ‘shoppable’ services: 

  • Discounted cash prices (use gross charges if cash prices are not available)
  • Payer-specific negotiated charges,
  • De-identified minimum negotiated charges
  • De-identified maximum negotiated charges

OR

Hospitals can use a patient estimator tool instead of ‘shoppable’ services.

We checked more than 5000 hospital websites to find machine-readable files and patient estimator tools. We analyzed the data to see if the hospitals are compliant with the CMS requirements and simplified the pricing data into a user-friendly format so that anyone can easily understand.

We want to help hospitals that are non-compliant to become compliant using our price transparency innovative Zeatool. Our goal is to help hospitals take this big pricing data, navigate new ways to cut waste, increase revenue, and bring the antiquated healthcare system into the E-commerce age. 

Once healthcare data is shoppable, consumers can know the cost of their healthcare services before receiving care. This pricing information is highly beneficial for uninsured, underinsured consumers and self-insured employers to price shop healthcare services. 

This report provides an analysis of the Other region of the United States.

How Do Hospitals in the Other region comply with CMS Price Transparency Requirements?

We analyzed 70 hospitals in the Other Region, found 10(14%) compliant, and 60(86%) are non-compliant with CMS requirements. As of April 6, 2021, the non-compliant hospitals will face a penalty of $300/day for a total of 1728000 and the penalty for each non-compliant hospital is $28,800.

We analyzed 1 hospital in American Samoa, found 0 (0%) hospitals compliant, and 1 (100%) hospitals are non-compliant with CMS price transparency requirements. The 1 non-compliant hospitals will face a total penalty of $28,800.

We analyzed 9 hospitals in the District of Columbia, found 3(33%) hospitals compliant, and 6(67%) hospitals are non-compliant with CMS price transparency requirements. The 6 non-compliant hospitals will face a total penalty of $172,800.

We analyzed 2 hospitals in Guam, found 0(0%) hospitals compliant, and 2(100%) hospitals are non-compliant with CMS price transparency requirements. The 2 non-compliant hospitals will face a total penalty of 57600.

We analyzed 56 hospitals in Puerto Rico, found 7(13%) hospitals compliant, and 49(87%) hospitals are non-compliant with CMS price transparency requirements. The 49 non-compliant hospitals will face a total penalty of  $1411200

We analyzed 2 hospitals in Virgin Island, found 0(0%) hospitals compliant, and 2(100%) hospitals are non-compliant with CMS price transparency requirements. The 2 non-compliant hospitals will face a total penalty of $57600.

There are no hospitals that have exceeded the CMS requirements by giving Chargemaster MR file, Shoppable Services MR file, and Estimator tools.

Leave a Reply

Your email address will not be published. Required fields are marked *