In an effort to ease achieving compliance with its newly instituted Hospital Price Transparency Rule, the Centers for Medicare & Medicaid Services (CMS) has recently published three sample formats on its website for hospitals to use as models.
The mandate, which went into effect in early 2021, requires hospitals to publish their standard charges for particular health care services in two ways: (1) a machine-readable file with all their items and services and (2) a display of their “shoppable services” in a “consumer-friendly format.” CMS believes that the new mandate will promote value-based health care by ensuring patients have access to quality and cost information. The hospital transparency mandate comes in the wake of similar efforts, such as the Transparency in Coverage Rule and No Surprises Act for insurers. You can view prior Steptoe & Johnson client alerts on Hospital Pricing Transparency here and here.
CMS has already begun auditing hospitals for compliance. In order to help with this process, CMS released the three sample formats — XML, JSON, and CSV — so that they can be “machine-readable.” The samples also contain the data elements that are required under the new rule. Current data suggests that around two-thirds of hospitals are in compliance with the rule, up from around 16% earlier in 2022. The sample formats from CMS can be accessed here.
If you have questions about the Hospital Price Transparency Rule, please contact one of the authors of this alert. Also, visit the Steptoe & Johnson Health Care Team on LinkedIn to keep up with the latest developments in health care law.