What you should know
- The Center for Medicare and Medicaid Services’ (CMS) final “OPPS” rule standardizes hospital MRF formatting, expands hospital MRF data elements, and enhances enforcement mechanisms around hospital MRF compliance.
- Rule provisions have varying compliance dates, ranging from 1/1/24 to 7/1/24 to 1/1/25.
- In addition to these requirements, last week CMS released several similar finalized payment rules, including those for hospital/ASC reimbursements, clinician reimbursements, and the 340B drug discount program. None of those other rules contain transparency provisions.
- CMS also published its Hospital Price Transparency GitHub repository, which includes technical specifications and an implementation timeline for the new requirements.
What this could mean for you
- Hospitals will be required to affirm the accuracy and completeness of their standard charge information displayed in their MRFs.
- Data elements (including coding info) must be included in the standard charge list to improve standardization of hospital MRF formats.
- Hospitals must meet specific formatting requirements for display of standard charge information using a CMS template.
- Specific monitoring/enforcement mechanisms related to these requirements, including actions CMS may take to address noncompliance of hospitals in health systems and publicizing assessments, compliance actions, and outcomes on the CMS website.
- While the rule’s requirements apply only to hospital MRFs, the rule could be a harbinger of more standardized formats and expanded or restricted data elements for health plan MRFs.