CMS CY22 OPPS Final Rule – Points To Know About Price Transparency

About Price Transparency

CMS did everything they proposed on transparency…including the very large increase in fines!

CMS has remained focused on the importance of Price Transparency, consistently stressing that their goal is to empower patients to make informed decisions regarding their health care. In their recent fact sheet, CMS called out what they called “sub-optimal compliance.”

We’ve covered these concerns before, as well as what our own research found. It’s true that some hospitals chose not to comply, but to wait to see some of their questions clarified, or to take on the penalty rather than over-invest in solutions or tools. Some hospitals believed they were compliant, when they were missing key components CMS required. Luckily, although some of these hospitals received letters warning of their missing tools or files, they have a period of time to correct the mistakes before CMS take any action.

But the action they can take just got more serious.

To encourage hospitals to comply CMS has dramatically increased the penalty for non-compliance. Beginning January 1, 2022, CMS will increase the penalty for some hospitals that are found to not be complying. They will set a minimum civil monetary penalty of $300 per day that will apply to smaller hospitals with a bed count of 30 or fewer, and a penalty of $10 per bed per day for hospitals with a bed count greater than 30, not to exceed a maximum daily dollar amount of $5,500. The minimum total penalty amount would be $109,500 per hospital, and the maximum total penalty amount would be $2,007,500 per hospital for a full calendar year of noncompliance.

This doesn’t change the current penalty for small hospitals but does dramatically increase it for larger facilities. It’s certainly something large hospitals need to be aware of, and those who made the decision to pause and wait for more clarity on transparency guidelines may need to seriously consider catching up with these dramatic penalties. (By the way, if you’re interested in help in that area, let us know!)

CMS also clarified that the machine-readable file must be accessible to automated searches and direct downloads. This will make it easier for patients to quickly find the information they need and may also help organizations who want to quickly aggregate and compare the data.

The new regulations go into effect on January 1, 2022.

We put together all our thoughts on Price Transparency in a summit you can watch for free here. If you have any questions or want to know how we can help you avoid the new CMS penalties, let us know!

To read the full fact sheet from CMS click here!


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