Prepping for 2019 CMS Price Transparency

CMS logo and phrases about medical pricing

Preparing for 2019’s CMS Price Transparency Response

October 9, 2018 By Robin Brand and Kenna Hawes
Excerpted from the Advisory Board*

In April 2018, CMS informed hospitals across the country that, effective January 2019, each hospital must post “standard charges” for all hospital inpatient and outpatient services online. A recently published FAQ on the topic contains additional detail. Here are the highlights:

How to thrive in a price-sensitive market

1) “Standard charges”: Each hospital must maintain a list of “standard charges” for all inpatient and outpatient services. These charges do not need to be payer-identifiable. CMS has said the charges can be posted directly from the chargemaster or can appear in another form, as long as they are reflective of charges present in the current chargemaster.

2) Posted online: Beginning January 1, 2019, each hospital in the United States must have posted its list of standard charges online (presumably on the hospital website). Charges must be formatted so that they are machine-readable (that is, easily analyzed by a computer). For example, charges posted in an XML or CSV format are acceptable, whereas charges posted in a static PDF are not.

3) Updated annually: Moving forward, each hospital must update its online list of charges at least once a year.

CMS hopes charge posting requirement will spur broader price transparency efforts

CMS seems to be fully aware that chargemaster prices will be of little practical use to patients. In the FY 2019 Inpatient Prospective Payment System Final Rule, the agency encourages hospitals to implement meaningful price transparency strategies, including working with payers and other third parties to post more helpful patient-centered price information.

All hospitals are required to post charges online. Exceeding requirements likely represents competitive advantage. READ FULL STORY…


*The Advisory Board is a client of EMS Healthcare Informatics.