Price Transparency Proposed New Rules: Are You Prepared?

As part of the proposed 2024 OPPS/ASC Final Rule, CMS is proposing several sweeping changes to the current Price Transparency rules that have been in effect since January 1, 2021. These proposed changes, driven by Congressional unhappiness with the hospital’s industry 70% participation rate for meeting the current standards, is intended to bring increased transparency to the current Machine-Readable File (MRF),and increased public awareness including monetary penalties for those hospitals that are not complying. The proposed effective date for hospital compliance with the proposed rules is January 1, 2024, with a 60-day delay allowed for implementation of the new MRF reporting requirements.

The proposed rules include the following updates to the current rules:

• Standardizing Access to Hospital Transparency Files
• Increased Accountability & Enforcement Including
  • Automated Policies and Audits
  • Hospital Certification of the Accuracy of the MRF
  • Public disclosure of the Hospital Points of Contact 
• Publicize Compliance, Actions, and Outcomes
  • CMS intends to make compliance actions against hospitals very public
• Enhancements to the current MRF date requirements:
  • General Information
  • Standard Charge Data Elements
  • Payer and Contracting Method Data Elements
  • Items and Service Information Data Elements
  • Billing and Coding Information

So, are you prepared for these changes? If not, what are your plans? While these are just proposed rules changes, don’t be surprised if much of what is proposed is included in the 2024 OPPS/ASC Final Rule. 

We can help. Microscope has a seasoned group of professionals that can assist you in complying with the new rules.   

For more information, please reach out to:

Terry Lang, CPA, FHFMA- Managing Principal, Reimbursement