Report: Most U.S. Hospitals Struggling with Price Transparency Compliance

October 3, 2022
hospital entrance

What is the Price Transparency Rule?

Hospital price transparency is intended to help Americans determine the price of a hospital item or service before receiving it. The price transparency rule went into effect on January 1, 2021. Each hospital in the United States is required to provide clear, accessible pricing information online about the items they provide in two ways:

  1. As a comprehensive machine-readable file with all items and services.
  2. In a display of shoppable services in a consumer-friendly format.

The goal: to make it easier for consumers to shop and compare prices across hospitals and estimate the cost of care before going to the hospital.

Is Your Hospital in Compliance with the Price Transparency Rule?

A new report from finds that most U.S. hospitals continue to be non-compliant since the price transparency rule went into effect.

The organization’s Semi-Annual Hospital Price Transparency Compliance Report indicates that just 16% of the 2,000 hospitals reviewed comply with the rule.

The August 2022 analysis of the hospitals across the U.S. found:

  • Only 319 (16%) complied with the rule.
  • 101 hospitals (5.1% did not post standard charges files and were in total noncompliance.
  • Two of the largest hospital chains in the U.S. are not complying.

The Cost of Non-Compliance

On June 9, 2022, The Centers for Medicare & Medicaid Services announced the first civil monetary penalties under the price transparency rule, fining two hospitals for alleged failure to make public their standard charges. Hospitals can face penalties ranging from $300 to $5,500 per day, depending on the hospital’s size.

How to Make Sure Your Hospital is in Compliance

Eide Bailly provides a variety of services to help facilities establish and maintain compliance with the price transparency rule.

If your organization has not started or is just beginning the work of creating the machine-readable file and it feels like an overwhelming task, Eide Bailly can help. We will assist your organization in compiling all the required data elements, such a current chargemaster and payer contracts. We will produce a compliant machine-readable file with all the negotiated rates by charge code by payer by plan. We can also generate the shoppable services file with the 70 CMS required services with a total of 300 items and services.

If you feel like your organization is complying but would like some assurance or a second set of eyes, we can also provide a compliance review of the machine-readable file, shoppable services file and/or the patient out of pocket estimation tool. We will provide a comprehensive list of the elements that may be at risk as well as a link to the specific area in the rule that addresses the issue.

Talk to our revenue cycle services team for more information about establishing and maintaining compliance with the price transparency rule.

Expand Full Article

We're Here to Help

We are here to help
From business growth to compliance and digital optimization, Eide Bailly is here to help you thrive and embrace opportunity.
Speak to our specialists