Are You Aware of the Latest CMS Enforcement Actions?

CMS has started enforcing the price transparency rule, by taking action against two hospitals. 

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This summer, the Centers for Medicare and Medicaid Services (CMS) fined two hospitals for failing to uphold the price transparency requirements. The hospitals failed to update their websites and/or respond to CMS’ letters about the violations. 

Northside Hospital Atlanta was fined $883,180 and Northside Hospital Cherokee was fined $214,320 for the violations. 

Pursuant to the price transparency rule, hospitals must make standard charges public. 

The rule also states that hospitals in the United States are required to provide clear, accessible pricing information online about items and services 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. 

Failure to comply may result in the issuance of civil monetary penalties by the CMS, as it did for the two hospitals above. 

As most healthcare entities are aware, the government has been working to ensure patients have more access to information regarding their billing and healthcare records. 

With surprise billing laws, HIPAA’s right of access initiative, and pricing transparency, it is essential that your healthcare entity is compliant with all applicable laws. Failure to comply can result in detrimental fines. 

If you have questions about what state and federal laws apply to your entity, and what you need to do to ensure compliance, contact us today. 

We can help you tailor your policies and procedures to be compliant and train your office staff to know how to respond to inquiries from the government. 

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