Hospital Price Transparency Requirements Effective January 1, 2020
Based on the CY 2019 Hospital Outpatient Final Rule (OPPS), the Hospital Price Transparency Policy will go into effect on January 1, 2021. This policy requires each operating hospital in the United States is to publish their pricing information for items and services they provide online in two ways.
- Comprehensive machine-readable file with all items and services, including:
- gross charges
- discounted cash prices
- payer-specific negotiated changes
- de-identified minimum and maximum negotiated charges
- Display of at least 300 “shoppable services” (or as many as the hospital provides if less than 30) in a consumer-friendly format. This must contain plain language descriptions of the services and group them with ancillary services. The display must include:
- discounted cash prices
- payer-specific negotiated charges
- de-identified minimum and maximum negotiated charges
Existing CMS guidance requires that all hospitals in the United States make their list of their current standard charges (whether in the form of a “chargemaster” or another form of the hospital’s choice) public online in a machine-readable format. This and to update this information annually. There are no hospitals operating within the United States with exemptions from this requirement under the current policy.
To read the October MLN Connects® article and review the additional resources available for hospital preparation, click here:
Display of at least 300 “shoppable services” (or as many as the hospital provides if less than 30) in a consumer-friendly format. This must contain plain language descriptions of the services and group them with ancillary services. The display must include:
