February 07, 2020

Data Crunch: CMS’s Arduous New Requirement that Hospitals Publish Pricing Information

By Joel McElvain, Esq. and Elizabeth Swayne, Esq., King & Spalding, Washington, DC

The Centers for Medicare & Medicaid Services (CMS or the Agency) recently finalized burdensome new requirements for hospitals to disclose the payment rates they have negotiated with third-party payors.  CMS asserts that it has the authority to impose these requirements under a provision of the Patient Protection and Affordable Care Act, although that statute only requires disclosure of hospitals’ “standard charges.”1 Previously, CMS had encouraged hospitals to simply post their chargemasters online.  The newly issued requirements, however, are much more onerous, requiring hospitals to publish multiple pricing lists, including not only their standard charges, but also negotiated rates with third-party payors.  Hospitals must comply with the new rules starting January 1, 2021.  Given the complexity of the rule and the volume of data it requires, and the Agency’s ability to impose corrective action plans and civil monetary penalties for violations, hospitals would be well advised to begin developing this data as soon as possible and to actively engage with the Agency, which is likely to issue additional sub-regulatory guidance over the next year.2

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