FAQ - Posting Standardized Prices

on Wednesday, 24 October 2018. All News Items | FAQ

Q:

Where can I find information about Medicare’s requirement for hospitals to publicly post their charges?




A:

You can find information in the FY 2015 IPPS/LTCH Final Rule (79 FR 50146) where CMS reminded hospitals of their obligation to comply with the transparency requirement under the Affordable Care Act.  

As a result of the Affordable Care Act, section 2718(e) of the Public Health Service Act requires that ‘‘[e]ach hospital operating within the United States shall for each year establish (and update) and make public (in accordance with guidelines developed by the Secretary) a list of the hospital’s standard charges for items and services provided by the hospital, including for diagnosis-related groups established under section 1886(d)(4) of the Social Security Act.’’

CMS’s guidelines for implementation required that hospitals either make public a list of their standard charges (whether that be the chargemaster itself or in another form of their choice), or have a policy for allowing the public to view a list of those charges in response to an inquiry.

In the 2019 IPPS/LTCH Final Rule, CMS finalized their proposed update to the guidelines that effective January 1, 2019 hospitals will be required “to make available a list of their current standard charges via the Internet in a machine readable format and to update this information at least annually, or more often as appropriate.”

CMS has recently released some Frequently Asked Questions on the topic.

There is also information on price transparency available from the American Hospital Association (AHA Toolkit for Achieving Price Transparency) and many local state hospital associations.  

Medical Management Plus, Inc., in coordination with our sister company, RealTime Medicare Data (RTMD) can help hospitals assess their charge structure and how it might compare to other facilities in their market. For more information, please contact Megan Wise via email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Article by Debbie Rubio

Debbie Rubio, BS, MT (ASCP), is the Manager of Regulatory Affairs and Compliance at Medical Management Plus, Inc.  Debbie has over twenty-seven years of experience in healthcare including nine years as the Clinical Compliance Coordinator at a large multi-facility health system.  In her current position, Debbie monitors, interprets and communicates current and upcoming regulatory and compliance issues as they relate to specific entities concerning Medicare and other payers.  You may contact Debbie at This email address is being protected from spambots. You need JavaScript enabled to view it..

This material was compiled to share information.  MMP, Inc. is not offering legal advice.  Every reasonable effort has been taken to ensure the information is accurate and useful.

 

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