Centers for Medicare and Medicaid Guidance Takes Effect January 1, 2021—Are You Prepared?

December 22, 2020 | Article

The Centers for Medicare and Medicaid Services (CMS) has issued a notice alerting hospitals of their plans to audit for compliance with the price transparency rules. These rules, which were first published on November 15, 2019, go into effect January 1, 2021. 

Effective January 1, 2021, each hospital operating in the United States is required to provide publicly accessible standard charge information online about the items and services they provide in two ways:

  • Comprehensive machine-readable file with all items and services.
  • Display of 300 shoppable services in a consumer-friendly format or a price estimator tool accessed on their website.

This notification confirms the expectations of the CMS that hospitals need to comply with the price transparency rules. It further confirms their intent to audit a sample of hospitals for compliance starting in January, in addition to following up on reports of noncompliance that can be reported directly to CMS. Hospitals not in compliance are at risk of civil monetary penalties.   

How to Maintain Compliance with New CMS Rules
Make sure you have a plan for compliance. Review your website to ensure you are meeting the two noted requirements above. Price transparency should be easily accessible on your website to ensure you are complying.

How to Get the Help You Need with the New CMS Rules
Eide Bailly has a deliverable for clients that produces the machine-readable file as well as the list of shoppable services file needed for compliance. In order to do this efficiently, we need a fair amount of data. The most difficult of this data will be the various fee schedules and payment methodologies for how providers are reimbursed by their contracted payers.

Let us help you become compliant in 2021.


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