Hospital Price Transparency Policy Updates
President Trump brings a new wave of focus on hospital pricing transparency with an executive order, “Making America Healthy Again by Empowering Patients with Clear, Accurate, and Actionable Healthcare Pricing Information” issued February 25, 2025. The new order calls on the Secretary of the Treasury, the Secretary of Labor, and the Secretary of Health and Human Services to implement and enforce new healthcare pricing transparency regulations by late May 2025.
The Affordable Care Act of 2010 laid the groundwork for hospital price transparency leading to the implementation of the Hospital Price Transparency Final Rule effective January 1, 2021 (45 C.F.R. Part 180). This established requirements to make public a list of standard charges and services provided by hospitals. This includes a machine-readable file with standard charges for all items and services and a consumer-friendly display of at least 300 shoppable services, including 70 CMS-specified shoppable services. The main goal of hospital price transparency is to provide comparable pricing to the public, to aid in informed care decisions.
The already existing regulations have drawn criticism from healthcare providers concerned about the administrative burden and potential misinterpretation of pricing data. With this executive order, updated regulation focus includes the actual price of items and services; updated guidance or regulatory action to ensure standard and easily comparable pricing information; and guidance or proposed regulatory action to ensure compliance with reporting accurate, complete and meaningful data.
In addition to the executive order, new regulations began January 1, 2025. Now, hospitals are required to include additional data elements such as estimated allowed amount, drug unit of measurement, drug type of measurement, and modifiers. Penalties for noncompliance include a written warning notice, request for corrective action plan, and the imposition of civil monetary penalties. As of early 2025, Centers for Medicare & Medicaid Services (CMS) has issued 7 notices of imposition of a civil monetary penalty, totaling over $500,000.
Ensuring adherence to the latest hospital price transparency regulations can be complex. Reach out to our team for expert guidance in assessing your compliance today.
Michelle Hammerle, CPA, CMA - Senior Consultant |
