Ensure Full Compliance and Avoid Penalties with SumHealth.
The Centers for Medicare & Medicaid Services (CMS) mandates for hospital pricing transparency are more than just guidelines – they're a critical compliance imperative. As a hospital, you're tasked with:
Publicly displaying standard charges for all items and services.
Making shoppable services available in a consumer-friendly format.
Ensuring accuracy and accessibility of pricing information.
At SumHealth, we understand the complexities and challenges hospitals face in complying with evolving CMS mandates. We specialize in providing comprehensive, tailored solutions that simplify the journey to full transparency. Our services are designed to:
Identify Gaps: We conduct thorough assessments of your current pricing data and disclosure practices to pinpoint areas of non-compliance.
Streamline Data: We help you organize, standardize, and optimize your pricing data to meet CMS specifications for machine-readable files and consumer-friendly displays.
Implement Best Practices: We guide you in developing and implementing robust processes for continuous compliance, ensuring your pricing information remains accurate and up-to-date.
The CMS mandates require hospitals to publicly display their standard charges in two main formats:
1. A comprehensive machine-readable file (MRF): This includes all items and services, gross charges, discounted cash prices, payer-specific negotiated charges for all third-party payers, and de-identified minimum and maximum negotiated charges.
2. A consumer-friendly display of shoppable services: This list of at least 300 common "shoppable" services (including 70 CMS-specified services) must be easily accessible and presented in a way that allows consumers to compare costs.
CMS has significantly increased civil monetary penalties (CMPs) for non-compliance. Penalties can range from $300 per day for smaller hospitals (30 beds or fewer) to up to $5,500 per day for larger hospitals (550 beds or more). This can result in annual penalties ranging from $109,500 to over $2 million per hospital for full calendar year non-compliance. CMS also publicly names non-compliant hospitals.
While your chargemaster is a foundational element, simply posting it is generally not sufficient for full compliance. The CMS mandates require a more granular and standardized disclosure, including payer-specific negotiated rates, de-identified minimum/maximum charges, and a consumer-friendly display of shoppable services, often necessitating a restructuring and optimization of your existing data.
SumHealth understands the resource constraints hospitals face. Our approach focuses on leveraging your existing data and systems where possible. We provide the expertise and tools to bridge the gaps, guiding you through data extraction, standardization, and formatting without requiring a complete system overhaul. Our goal is to streamline the compliance process efficiently.