CMS Introduces Updated Tool to Aid Hospitals in Price Transparency Compliance

The Centers for Medicare & Medicaid Services (CMS) modernized version 2.0 of their online validator tool in place to quickly align with the price transparency requirements of hospitals. The requirement from 2021 as directed to the hospital should be to automatically publish machine-readable files setting standard charges for services and items that include all the gross charges, payer-specific negotiated rates, allowing de-identified minimums and maximums, and discounted cash prices.

The new version enables hospitals to check their machine-readable files against new format and data specifications, indicating “errors” and “warnings” to help them make corrections. Errors indicate noncompliance with requirements that will be effective July 1, 2024, while warnings indicate standards that will be enforced from January 1, 2025. According to CMS, the tool stops reviewing if errors exceed 250 or if critical data elements in rows 1-3, which include headers and standard charges, are flawed.

In all these years of enforcement, the compliance rate is still relatively low. According to the report from PatientRightsAdvocate.org just published, only 34.5% of hospitals are completely compliant with the requirements- those are posting machine-readable files and offering consumer-friendly pricing for 300 common shoppable services or a price estimator tool. Noncompliance is widespread, with 65.5% of hospitals either providing incomplete files or failing to clearly associate prices with payers and plans.

True transparency and facilitating customer comparison as well as research can be supported through machine-readable files. Although CMS emphasizes that it does not provide certification of full compliance, it does offer a proactive measure for its hospitals to comply with the regulatory requirements.

A healthcare facility can upload files in both .json and.csv formats. CMS does not track the usage of an individual validator but may use this in compliance reviews. This notice underlines CMS’s commitment to strengthening its focus toward helping its clients as a hospital make price transparency in such complex pricing structures.

 

 


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