Price Transparency Compliance Enforcement Is On The Rise

Earlier this month, CMS announced they’d sent almost 500 warning letters to hospitals for transparency noncompliance. This represents one of the most significant surges in noncompliance notices since the Hospital Price Transparency Rule went into effect. CMS has hinted they would take “aggressive additional steps” to enforce requirements for hospitals, and with the last fines handed out in June 2022, it’s likely only a matter of time before more warning letters and fines are sent.

We don’t claim to be Uncle Sam, but we've scanned a lot of machine-readable files (MRFs) since the mandate went into effect in January 2021. Of the 5,320 MRFs we’ve crossed paths with, we consistently found the same or similar errors. Both providers who created their own MRFs and providers who contracted with a compliance vendor to handle their price transparency compliance have areas for improvement. Below is a checklist of the three most common mistakes to avoid. The good news is you can check for all three yourself in the next five minutes without any technical knowledge. Read on if you aim to get your MRF in ship shape in time to watch every March Madness game (or the Oscars…you do you!). If you don’t like sports, still read on to spite me.

Three Quick Ways To Check Common Machine-Readable File Mistakes

Machine-Readable File QA Check #1: Make sure your file name matches the CMS schema

It’s all the rage to come up with unique spellings for names these days. Why go by Ashley when you could go by Asheleigh, after all?

Sadly, CMS isn’t here for the Ashlees or Ashlis of the world. MRFs are all Ashleys. But, this one is easy to fix. Go to your MRF page and download your file. Cross-reference the file name with the required name from CMS below:

Your file name must match this exactly. That means you need to:

  • Use “_” instead of a space
  • Use your EIN instead of an NPI.
  • Standardcharges, with no space.
  • And only use JSON, XML, or CSV file extensions. An excel file in XLSX won’t cut it. If your hospital is large, we recommend using JSON to handle the size of your file.

Machine-Readable File QA Check #2: Post your cash rates separately in your file and not as a text disclaimer
While it may be tempting to post cash rates as a text disclaimer at the top of your file, they must clearly be listed as separate rates in your file. Too often, a vendor will put a text disclaimer at the top noting that “the cash rate discount is 20% of list price” and call it complete. This action has triggered CMS warning letters in the past.

To fix this, take your list price, subtract your cash rate discount, and ensure the results are listed clearly in the MRF. We’ve seen instances where compliance vendors may omit cash rates entirely. CMS will not assume that a file without a cash rate should be interpreted to mean that the List Price and Self Pay Cash Price are the same value. Include both in the file, even if they are the same value.

Machine-Readable File QA Check #3: Patient Estimator Tool requires patient information to display prices

The patient estimator tool requirement is meant to make it easier for a patient to translate your MRF in a real-world use case. However, if your tool requires the patient to input information before accessing prices, you may get a warning letter from CMS.

We recommend allowing patients to contact you if they have questions, but display your prices in an easy-to-understand format without requiring patient information upfront. Here’s an example of an estimator we built for a hospital that does exactly that. In addition, if you’re making improvements to your patient estimator tool, consider posting a file with the 300 required shoppable services as an interim solution to maintain compliance with this portion of the Hospital Pricing Transparency Rule.

Don’t feel like you can’t audit your compliance vendor

If you find any errors and are currently using a vendor for compliance, message them immediately to resolve the issue. And, if you’re looking for a partner to review your current files or patient estimate tool, reach out to us here, and we’ll do an assessment and see if we can help. For free.

Finally, check how your hospital ranks against other similarly sized facilities by searching for your system or individual location here. You’ll see our recommendations based on a 5-star scoring system. Score less than a 5 and want to improve? We’ll walk through our scoring process and highlight any room for improvement. Score 5 and want to show off? Claim your facility on your profile page to become Turquoise Verified. We’ll evaluate the contents of your file, provide additional recommendations, and give you that Verified badge as an impartial 3rd party validation of your commitment to transparency.

Let’s Make 2023 The Year Of Less Patient Confusion

2023 looks like the year of Hospital Rule auditing and enforcement, so now is a good time to get your compliance ducks in a row. Completely accurate files and estimates minimize patient confusion and lay the foundation for fair healthcare prices across the industry.

Questions on your files or patient estimate tools? We're all ears.