Price Transparency is Here to Stay: CMS Sending Out Compliance Warning Letters


See how the transparency mandate can be an opportunity to accelerate the development of digital consumer strategies and build greater trust with patients.

The Centers for Medicare and Medicaid Services has started issuing warning letters to hospitals that haven’t yet complied with the price-transparency rule, a clear indication the agency’s enforcement efforts will likely ramp up in the months ahead.

The rule, which took effect Jan. 1, is designed to help consumers and purchasers shop more effectively for healthcare services. It requires hospitals to publicly post a range of pricing information, including discounted cash prices, payer-specific negotiated prices, minimum and maximum negotiated rates, and prices for 300 shoppable health services.

A recent study found that 65 out of 100 hospitals sampled had not complied with the rule. CMS began sending out warning letters in April to hospitals that hadn’t yet posted their pricing, according to published reports. Once a noncompliance letter has been received, hospitals have 90 days to address the issue. If hospitals fail to comply with the rule, CMS could fine them $300 per day and/or make the penalty public. Some congressional leaders are calling for CMS to step up compliance audits and revisit the penalty amount in view of widespread noncompliance. 

Change Healthcare sees the transparency mandate as an opportunity for hospitals to accelerate the development of their digital consumer strategy while building greater trust with patients. Our Clearance Estimator Patient Direct and Shop Book and Pay™ solutions enable consumers to receive accurate estimates of out-of-pocket expenses at or before the point of service. We can help you comply with the pricing-transparency regulations as part of a broader strategy for creating a comprehensive, retail-style healthcare-shopping experience.

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