Beginning January 1, 2021 all hospitals in the US will be required to disclose standard charges for services and items offered to their patients. Many hospitals already do this, but the Centers of Medicare and Medicaid Services (CMS) finalized policies that will require hospitals to be more accountable of prices they charge and more transparent information. Hospitals have been required to publicly state their standard charges since 2015 and accessible online in an electronic format since the beginning of 2019. 

The 2020 Hospital Outpatient Prospective Payment System (OPPS) final rule goes one step further to define: 

  • The terms hospital, standard charges, and items and services.
  • Requirements for making public all standard charges for all items and services
  • Requirements for displaying shoppable services
  • Monitoring and enforcement actions

Defining terms hospital, standard charges, and items and services:

For this policy, a hospital is an institution in any state, includes US territories, districts, and provinces, in which state or applicable local law provides for the licensing of hospitals. Federally owned hospitals that do not treat the general public are already in compliance. 

Standard charges include gross charges on a hospital’s chargemaster, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.

Items and services can be defined as all items and services that could be provided by the hospital to an inpatient admission or outpatient department visit for which the hospital has established a standard charge.

 

Learn more on next week’s blog post for more information on the 2020 Hospital Outpatient Prospective Payment System (OPPS) final rule!