Medicare Compliance & Reimbursement

Most hospitals are required to let their patients know the cost of items and services. The HHS Office of Inspector General (OIG) just added hospital price transparency to its Work Plan to gauge how the facilities are doing with these requirements.

Nuts and bolts: As part of a final rule that went into effect on Jan. 1, 2021, the Centers for Medicare & Medicaid Services (CMS) mandated certain hospitals list their prices for items and services. “Most institutions in the United States that are licensed as hospitals or otherwise approved as meeting applicable licensing requirements must post their standard charges prominently on a publicly available website,” CMS explains further on its webpage.

CMS outlined in the final rule items and services that hospitals must list, gross charges, payer-specific negotiated charges for each item or service, discounts, and codes the hospital should use, OIG reminds in Work Plan Active Item WA-22-0013 (W-00-22-35890).

Now: To better assess CMS’ monitoring of hospitals’ price transparency as well as how the agency is imposing penalties for noncompliance, OIG determined an audit of the rule implementation was necessary. “We will review the controls in place at CMS and statistically sample hospitals to determine whether CMS’ controls are sufficient to ensure that hospital pricing information is readily available to patients as required by Federal law,” OIG says. “Additionally, if hospitals are not in compliance with CMS’ rule for listing their charges, we will contact the hospitals to determine the reason for noncompliance and determine whether CMS identified the noncompliance and imposed consequences on the hospitals,” the federal watchdog warns in the Work Plan listing.

Find the Action Item at https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000728.asp.