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August 04, 2023

Nonprofit Organization Conducts Survey, Finds Only 36% Percent of Hospitals Surveyed Were Compliant with Price Transparency Rule

The Federal Price Transparency Rule (“Rule”) became effective on January 1, 2021.  This Rule requires hospitals to post their prices online in a form that is easily accessible and searchable.  The Patients Right Advocate (“PRA”) organization noted in its fifth semi-annual  compliance report that out of two thousand hospitals, only thirty-six percent were fully compliant.  The noncompliance appears to stem from most of the hospitals having incomplete files or having prices that are not clearly associated with plan and payer.  PRA notes that this ongoing noncompliance overall impedes the ability of patients, tehcnology developers, and employers and unions purchasing health care services to analyze and compare prices. 

PRA also examined enforcement of penalties by CMS.  In June 2022, CMS imposed the first monetary penalties on two hospitals that promptly came into compliance after the monetary penalty was issued.  At the time of PRA’s 2023 report, four hospitals total have been fined since the Rule became effective.  PRA states that the report demonstrates the need for more robust enforcement and uniform standards on pricing to increase compliance and protect from overcharges, errors, and fraud. 

On July 13, 2023, CMS took action in this regard when it proposed changes to the price transparency rule as part of the annual OPPS/ASC proposed rule for calendar year 2024.  These changes would enhance standards for posting prices and strengthen the enforcement process.  If finalized, the changes would go into effect on January 1, 2024.  The rule was published in the Federal Register on July 31, 2023, and the comment period is open until September 11, 2023.

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