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CMS Updates Price Transparency Penalty

By: Dean Dorton | November 19, 2021

On November 2, 2021, the CMS released the Calendar Year 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule.

Healthcare

On November 2, 2021, the CMS released the Calendar Year 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System final rule. In this final rule, the civil monetary penalties (CMP) for noncompliance with the price transparency requirements will increase based on a bed count and some activities that present barriers to accessing machine-readable files will be prohibited.

The minimum CMP for noncompliance for hospitals with 30 or fewer beds will be $300 per day. An additional penalty of $10 per bed per day will be imposed to hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500. With these criteria, the minimum annual CMP will be $109,500 and the maximum CMP will be $2,007,500.

Many hospitals have been found to be noncompliant also with the requirement of access to machine-readable files, as CMS noted that some hospitals had embedded the file in websites without any ability for users to easily or directly download a single machine-readable file. CMS is now requiring that hospitals “must ensure the standard charge information is easily accessible, without barriers, including, but not limited to, ensuring the information is accessible to automated searches and direct file downloads through a link posted on a publicly available website.”

Price transparency rules of 2020 were delayed to 1/1/21, so CMS has the position that there is no reason for delay in complying. 

We are available to assist hospitals with meeting these Price Transparency requirements. Contact us for assistance.

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