The Centers for Medicare and Medicaid Services’ Hospital Price Transparency rules can seem complex and understanding what they mean to you and your facility can be challenging.

The basic tenants of the price transparency rules can be summed up with three main requirements for hospital systems:

Give consumers real-time, personalized access to cost-sharing information.
Disclose the price hospitals negotiate with insurance providers.
Create a list of 300 “Shoppable” Services, including 70 that are directly selected by the CMS.

Facilities that do not comply with Hospital Price Transparency rules can face required corrective actions including fines of up to $5,500 per day!

	Compliance Guidance on specifically how to best comply with the new requirements Compliance audits of your current or drafted systems and policies
	Revenue integrity Building a replicable process for you to extract the data needed to meet CMS’s reporting requirements and appropriately translate data for consumers, on a recurring basis Review and assistance with development and maintenance of a pricing strategy that meets CMS price transparency objectives alongside the industry move to value-based reimbursement models Assessment of payer compliance and assistance with payer contract negotiations/discussions, including helping to level-set revenues and reimbursements per contractual agreements
	Data and technology Development and optimization of data extraction and compilation systems Automation of processes (e.g., updating standard and shoppable services in real time)
	Audit/Assurance Data integrity in the transfer of data between systems Analysis around developing a value-based proposition and pricing strategy
	Cyber and interoperability Data integrity and security analyses Assessment of data exchange with vendors and other internal and external entities