OPPS Final Rule on Hospital Price Transparency ─ Substantial increases of financial penalties for non-compliance under the hospital price transparency rules.

The Centers for Medicare & Medicaid Services (CMS) released the 2022 Outpatient Prospective Payment System (OPPS)/Ambulatory Surgery Center (ASC) Payment System final rule (OPPS Final Rule), finalizing several policies proposed, including provisions of the Hospital Price Transparency, substantially increasing financial penalties for non-compliance.

​A full year of non-compliance with the price transparency regulation can potentially result in a maximum penalty of about $2 million per hospital.

Earlier in the year, CMS proposed to significantly increase financial penalties on hospitals for non-compliance with CMS's price transparency rules, known as the Hospital Price Transparency Rule. Currently, penalties for non-compliance with CMS's price transparency rules may not exceed US$300 per day. In the final proposed ruling, the price transparency policies increase the dollar amount of a Civil Monetary Penalty (CMP) that CMS may impose on a hospital for non-compliance. Beginning 1 January 2022, the new penalties per hospital are summarized below: 

Hospitals with 30 or fewer beds that are not compliant with the required provisions will face a minimum $300 per day penalty. The minimum penalty for hospitals with more than 30 beds is $10 per bed per day. There is a maximum penalty cap set at $5,500 per day. An entire year of non-compliance with the price transparency regulation would result in a maximum penalty of about $2 million per hospital.

As CMS has proposed to use a hospital's bed count to calculate the amount of the daily penalty, the OPPS Proposed Rule illustrates methodologies that will be used to determine a hospital's bed count. The determination varies depending on if a hospital is a Medicare-enrolled hospital or a hospital that is not Medicare-enrolled. CMS proposes utilizing the hospital's documentation to determine the number of beds in a form and manner prescribed by CMS. A hospital that fails to provide CMS with this documentation would be assessed a CMP at the highest, maximum daily dollar amount.
 
In addition to increasing the CMP for non-compliance, CMS also finalized its proposal to update the Rule's prohibition of certain activities that it views as barriers to accessing the machine-readable file. Therefore, CMS will now explicitly require that the machine-readable file be accessible to automated searches and direct downloads.
 
The objective of hospital price transparency is to help consumers know what hospital charges for the items and services they provide in order for individuals to make informed decisions about their health care and to manage associated costs. Though enforcing activities to ensure compliance is necessary with price transparency, CMS is also committed to engaging with hospitals to help them understand and meet requirements.
 
Access the CMS fact sheet on the OPPS/ASC Final Rule to determine your facility's reediness and the proper steps to prepare.