Read part one of this blog here.
Requirements for making public all standard charges for all items and services:
Hospitals must compile standard charges for all items and services offered by the hospital in an electronic file which needs to be displayed on the hospital’s website. The electronic file must include a description of each item or service, as well as the medical code(s) used for billing.
The electronic file must be open-access and free to use by the public without requiring any kind of submission of personal information or a password. The data in the file must be updated at least annually and clearly marked when the last update to the file occurred.
Requirements for displaying shoppable services:
Hospitals must make a public standard charge list for at least 300 shoppable services available in a consumer-friendly manner. Shoppable services can be defined as services that can be scheduled in advance by the healthcare consumer.This public standard charge list must include a description of each shoppable service that healthcare consumers would understand, an indicator when one or more of the CMS specified services are not offered, the location at which the shoppable service is provided, and if the standard charge for that particular service still applies at that location.
The list must also list the most common shoppable services based on billing rate or utilization. It must also include charges for services the hospitals customarily provides with the primary service with the common billing code.
CMS will say a hospital has met these requirements if the hospital maintains an internet-based price estimator tool that meets the above requirements.
Monitoring and enforcement actions:
CMS will monitor hospital compliance by evaluating complaints made to CMS by individuals or entities. These complaints will be reviewed, and the offending hospital’s website will be audited.
The hospitals found to be noncompliant must submit or comply with the requirements of a corrective action plan or may be subject to a civil monetary penalty in excess of $300 per day.
CMS says it will post the corrective action on its website, but there is an appeals process for hospitals.