CMS recently imposed civil monetary penalty (CMP) to two more hospitals for alleged price transparency violations. The Centers for Medicare & Medicaid Services is taking strict and serious actions to enforce its price transparency rule that took effect on January 1, 2021.
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 was fined $102,660, and the Kell West memorial hospital received a $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.
The hospital price transparency law requires all hospitals to post the chargemaster standard charges and the prices for 300 shoppable services on their website in a consumer-friendly manner. The prices include:
- Gross charges.
- Discounted cash prices
- Payer-specific negotiated charges.
- De-identified minimum negotiated charges.
- De-identified maximum negotiated charges.
As of April 2023, CMS issued more than 730 warnings, and 269 corrective action plan requests to hospitals not complying with price transparency laws.
Will More Hospitals be Penalized?
CMS requires hospitals to be transparent and publish their hospital prices for public access. Transparency of prices makes healthcare more accessible for all as they get to choose the services per their budget.
The Centers for Medicare & Medicaid Services has been urging hospitals to comply with the mandate, with just two fines issued before.
However, the government is now ready to take a tougher & strict approach.
According to a Fact Sheet CMS Price Transparency Enforcement Updates, CMS is streamlining the compliance process. The agency proposes issuing fines “earlier and automatically” for hospitals failing to comply.
It includes a 90-day window for hospitals to comply after receiving the warning notice. In addition, if hospitals fail to submit a corrective action plan within 45 days of being notified, they will be fined automatically.
In addition, the CMS says it will no longer issue warning notices but immediately direct hospitals to submit a corrective action plan.
How ZeaHealth can Help You Comply?
ZeaHealth has been committed to healthcare price transparency since 2019 and we developed ZeaTool– our AI-powered price transparency compliance platform.
Through Zeatool and our expertise, hospitals can publish chargemaster standard charges and 300 shoppable services data in a machine-readable format. We also provide estimator for hospitals that meet the CMS price transparency requirements. Zeatool has built-in analytics capability and provides insights to providers about competitor analysis.
It compares their gross prices, cash prices, minimum negotiated rates, maximum negotiated rates, and each insurance negotiated rate.
In addition, they can run their data against the compliance engine to see if they meet the CMS criteria.
We have analyzed data from over 5000 hospitals using this tool and found many hospitals who are still non-compliant with CMS mandatory requirements.
Besides, we have also created ZeaMed – a consumer marketplace app that will transform the data collected in Zeatool from hospitals and other healthcare providers into a consumer-friendly format.
ZeaMed allows consumers to find and compare actual 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.
What can hospitals expect in the coming months?
CMS plans to take aggressive steps to prioritize action against hospitals failing to comply with the transparency law.
So, if you want to save millions of dollars of CMS penalties (up to $2M), contact us. We can help you become compliant with our price transparency engine, ZeaTool effortlessly.
The tool can clean your data and transform your complex pricing data into a simple CMS-required format.
We are committed to making all hospitals compliant with CMS Price Transparency Rule. This will align with our mission to make healthcare shopping as simple as airline booking.
Visit ZeaTool.com for more information or reach out to us at info@zeamedhealth.com.
