On January 1, 2021, CMS laid down the price transparency rule, which requires hospitals to publish their healthcare prices publicly. Now the Centers for Medicare & Medicaid Services is taking serious actions to enforce the mandate. Price compliance for hospitals is the need fo the hour.

The Price Transparency Mandate requires hospitals in the United States to publish their standard charges in a consumer-friendly format on their websites. Hospitals failing to comply with the mandate will be fined $300 per day for up to 30 beds, and beds above 30 will pay $10/bed/day not exceeding $5500. This 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 display that includes the following 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

Which two hospitals were penalized by CMS in 2023?

Frisbie Memorial Hospital in Rochester, New Hampshire, and Kell West Regional Hospital in Wichita Falls, Texas received the fines on April 19, 2023 by CMS. 

The Frisbie memorial hospital, a 58-bed facility, was fined $102,660, and the Kell West memorial hospital, 41 beds facility, received $117,260.

Nearly a year ago, on 6/7/2022 the CMS fined Atlanta-based Northside Hospital $883,180 and Northside Hospital Cherokee in Canton, Ga $214,320 for violating federal price transparency laws. 

Will CMS be more strict in the future? 

CMS is gearing up to check all American hospitals for price transparency. CMS will start issuing a CAP request, and 45 days will be the window for correction. CMS will contain all the hospital files before it penalizes a hospital. CMS has already issued 730 warning notices. It has also requested 269 CAPs.

How can ZeaHealth promote compliance with healthcare costs?

ZeaHealth can help hospitals and insurance companies comply with the price transparency mandate with its AI-powered price transparency compliance engine- ZeaTool

ZeaTool gathers hospital pricing data using the RPA technology and converts them into a CMS-required format. We have analyzed data from over 5000 hospitals using ZeaTool. We help hospitals publish chargemaster standard charges and 300 shoppable services data in a machine-readable format. We also provide estimator tool for hospitals that meet the CMS price transparency requirements.  

Zeatool compares gross prices, cash prices, minimum negotiated rates, maximum negotiated rates, and each insurance negotiated rate. The tool also has built-in analytics capability and provides insights to providers about competitor analysis.In addition, hospitals can check their compliance status and see if they meet the CMS criteria.

You can visit www.Zeatool.com to know more or also request a demo.