Are you ready to comply with the new Hospital Pricing Transparency Requirements? Have you started on your calculations yet? Is this project a priority right now? If not, it’s time to take serious action.

The rule requires hospitals to publish their negotiated rates for certain services with insurers by January 1, 2021.

Two broad requirements of the rule are:

  • Producing annually a machine-readable file of “standard charges for all hospital items and services (including gross charges, discounted cash prices, payer-specific negotiated charges, and deidentified minimum and maximum negotiated charges).”
  • Displaying online “discounted cash prices, payer-specific negotiated charges, and deidentified minimum and maximum negotiated charges for at least 300 ‘shoppable’ services.”

Why should I be concerned?

The calculations themselves are more than simple copy and paste into a Microsoft Excel® document and post online.

Consider the following:

  1. Time crunch—this rule was contested in court by the American Hospital Association and it was upheld—now you only have 6 months to comply
  2. Complexity—the rule requires hospitals to perform complex calculations/analysis to generate the required files
  3. Stretched resources—you may not have the expertise or available manpower to comply by January 1, 2021

What happens if I don’t comply?

Various penalties are possible.

Hospitals that do not meet the rule’s requirements by January 1, 2021 face a range of possible actions, including:

  • Warning notices
  • Requests for corrective-action plans
  • Levies of civil monetary penalties of up to $300 per day
  • Publicizing of penalties (which could put your hospital at a competitive disadvantage if patients would rather choose a provider that is complying with the rule)

We need help, now what?

We are helping many hospitals (of all sizes) comply with these requirements by performing analysis and calculations for them. Dean Dorton’s healthcare consulting team has the right experience and expertise to help you with the calculations, analysis, and compilation of the list required to comply by January 1, 2021. We provide hospital price transparency services which include the following:

  1. Update your machine-readable Standard Charge files with payer-specific negotiated rates
  2. Analyze the hospital’s prior year volume to identify the facility’s top 300 shoppable services
  3. Create a list of the hospital’s top 300 shoppable services with payer-specific negotiated rates

Adam Shewmaker, FHFMA
Director of Healthcare Consulting Services • 502.566.1054

More information:

Calendar Year (CY) 2020 Outpatient Prospective Payment System (OPPS) & Ambulatory Surgical Center (ASC) Price Transparency Requirements for Hospitals to Make Standard Charges Public final rule (CMS-1717-F2):

Final Rule

Fact sheet on the Transparency in Coverage Proposed Rule (CMS-9915-P):

Fact Sheet