The Centers for Medicare & Medicaid Services (CMS) is taking significant strides to enforce price transparency compliance for 2024 strictly. With a keen focus on empowering patients with the prices for care ahead of time, CMS proposes changes in the hospital price transparency mandates.
CMS is adding more requirements for hospitals to maintain a machine-readable file of the cost of their services.
What are the latest additions in the 2024 Final Rule?
Currently, the hospitals must list the hospital’s gross, payer-specific negotiated charges, maximum and minimum deidentified negotiated charges, and cash-discounted prices in the machine-readable files (MRF).
According to the 2024 proposed rule, CMS proposes hospitals to display standard charges data with a CMS template in multiple formats. CMS also requires hospitals to encode all standard charges information, including:
- The name, license number, and location of hospitals.
- Each standard charge type and expected charge in dollar amounts for items or services. (It will help eliminate large number of fields that are left blank or filled in with “n/a”)
- A description of items or services for standard charges, including information about inpatient or outpatient services.
- Drug unit and type of measurement
- Any relevant modifier and the applicable code type (HCPCS, CPT, etc.)
- Codes used for accounting or billing purposes, such as modifiers.
- The file version number with date of the most recent update.
CMS also proposes that hospitals submit a certificate that verifies hospital compliance. The certificate proves data accuracy and completeness, acknowledges warning notices received, and includes notifications sent to hospital leadership.
CMS Strict Enforcement Actions- Fines 3 Hospitals for Price Transparency Violations
The Centers for Medicare & Medicaid Services (CMS) is strictly enforcing the hospital price transparency mandate through monetary penalties. Recently, CMS imposed a Civil Monetary Penalty (CMP) on three more hospitals for alleged violations of the price transparency mandate in addition to the four hospitals that were penalized before.
3 Hospitals Penalized by CMS for non-compliance-
As per the new changes in the Price transparency mandate, CMS will now automatically impose a civil monetary penalty on non-compliant hospitals. Hospitals that fail to submit a Corrective Action Plan at the end of the 45-day CAP submission deadline will be penalized automatically.
With the hospital price transparency mandate, CMS aims to make hospitals’ pricing data accessible to patients. The agency wants to empower consumers with costing information, enabling them to make informed healthcare decisions.
How Can ZeaHealth Help You Avoid Penalties?
ZeaHealth can help hospitals and insurance companies save millions of dollars in penalties. We have been committed to healthcare price transparency since 2020 and have developed ZeaTool– our AI-powered price transparency compliance engine.
With ZeaTool, we help hospitals clean their chargemaster data and publish chargemaster standard charges and 300 shoppable services data in a machine-readable format. We also provide an estimator tool for hospitals that do not use MRF. In addition, hospitals can run their data against the compliance engine to see if they meet the CMS criteria.
Price Transparency is not limited to just compliance. Hospitals can use the price transparency market to gain a competitive edge. Since we have collected 3500+ hospitals’ pricing data, we offer insights into competitor data.
It compares their gross prices, cash prices, minimum negotiated rates, maximum negotiated rates, and each insurance negotiated rate.
Healthcare providers can also partner with ZeaHealth to gain more visibility among consumers through ZeaMed marketplace.
ZeaMed allows consumers to find and compare costs for healthcare services in their locality. In addition, they can see the quality of providers using CMS quality rating data, book, and pay for the services. Hospitals can publish their transparent pricing data on ZeaMed and get access to more patients and increase their revenue.
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