Medicare Compliance

CMS releases tool to help hospitals with price transparency

April 2, 2024 - CMS recently released a web-based validation tool that assists hospitals with price transparency compliance. The updated V2.0 Online Validator Tool helps hospitals develop machine-readable files to comply with a federal price transparency regulation that went into effect in 2021. The regulation requires, among other obligations, hospitals to...

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Little progress made with hospital price transparency compliance

by Jacqueline LaPointe

Hospitals have made little progress with implementing federal price transparency requirements that took effect in 2021. The latest semi-annual “Hospital Price Transparency Report” from...

Providers See Fourfold Increase in External Payer Audits

by Jacqueline LaPointe

2023 has been a big year for healthcare revenue integrity, with teams managing about four times more external payer audits in the last year. The finding from the latest “MDaudit Annual Benchmark...

Regulatory Burdens in Healthcare Take Away from Patient Care

by Jacqueline LaPointe

Regulatory burdens in healthcare, such as prior authorizations, surprise billing requirements, and audits and appeals, are taking resources away from patient care as practices face more...

OPPS Rule to Update Outpatient Payments, Hospital Price Transparency

by Jacqueline LaPointe

CMS proposes in the Outpatient Prospective Payment (OPPS) rule to increase Medicare outpatient payments by 2.8 percent next year while bolstering hospital price transparency enforcement. The OPPS rule...

Back to the Basics, Other Payment Integrity Strategies Post-PHE

by Jacqueline LaPointe

After an unprecedented three years, it’s time to return to the basics, according to Jordan Kearney, partner at Hooper, Lundy, and Bookman and founder of the firm’s Medicare Audits and Appeals Practice Group. By that, she means...

CMS Withdraws COVID-19 Vaccine Mandate for Healthcare Workers

by Jacqueline LaPointe

CMS has formally withdrawn the COVID-19 vaccine mandate for healthcare workers, according to a final rule published in the Federal Register today. The Omnibus COVID-19 Health Care Staff Vaccination...

HHS to Start Unwinding COVID-19 Vaccine Requirement

by Jacqueline LaPointe

HHS and DHS are starting the process of ending the COVID-19 vaccine requirement for CMS-certified healthcare facilities, as well as Head Start educators and certain noncitizens at the borders. The...

CMS Cracks Down on Hospital Price Transparency Compliance

by Jacqueline LaPointe

CMS is cracking down on hospital price transparency compliance — or lack thereof. The federal agency announced yesterday updated enforcement procedures, including earlier and automatic civil...

Price Transparency Rule Compliance is Growing But Needs More Oversight

by Victoria Bailey

More than two years after the hospital price transparency rule went into effect, provider compliance is increasing, according to a report from Turquoise Health. The software company’s Price...

Negotiated Prices for Surgical Procedures Higher in Hospital Networks

by Victoria Bailey

Negotiated prices for surgical procedures were higher at facilities within hospital networks compared to independent hospitals, according to a study published in JAMA Network Open. The hospital price...

CMS Eyes Stricter Enforcement of Hospital Price Transparency Compliance

by Jacqueline LaPointe

Hospital price transparency compliance is a top priority for CMS, which plans to take “aggressive additional steps” to identify hospitals lacking required pricing information on their...

KFF Study: Hospital Price Transparency Data Messy, Inconsistent

by Jacqueline LaPointe

Hospital price transparency data shared with the public is lacking in quality, challenging the usefulness of the information, according to Kaiser Family Foundation (KFF). KFF analyzed hospital price...

Only 25% of Hospitals Are Complying with the Price Transparency Rule

by Victoria Bailey

Less than a quarter of hospitals are complying with the hospital price transparency rule over two years after the regulation went into effect, according to a report from PatientRightsAdvocate.org. The...

CMS Offers Up New Hospital Price Transparency Resources

by Jacqueline LaPointe

CMS has published on its website new hospital price transparency resources to help hospitals meet the federal requirement to make certain standard charges available to the public via a machine-readable...

More Hospitals Complying With Price Transparency Rule Requirements

by Victoria Bailey

Almost two-thirds of hospitals are complying with hospital price transparency rule requirements and have published machine-readable files with negotiated rates or cash rates, according to Turquoise...

SCOTUS Won’t Hear Healthcare Vaccine Mandate Case Again

by Jacqueline LaPointe

The Supreme Court has declined to hear a challenge of the healthcare vaccine mandate brought on by 10 states claiming the mandate is an overreach of the federal government’s power over states and...

Healthcare Compliance Will Be a Challenge in Post-PHE World

by Victoria Bailey

The COVID-19 public health emergency (PHE) declaration was accompanied by several waivers and flexibilities that made it easier for healthcare providers to care for patients amid a global pandemic. Expanded telehealth coverage, Stark Law...

Cancer Centers Fail to Comply with Hospital Price Transparency Rule

by Victoria Bailey

Less than one-third of hospitals with National Cancer Institute (NCI) cancer center designation were fully compliant with the CMS hospital price transparency rule, according to research published in...

Hospital Price Transparency Compliance Lags Nearly 20 Months Later

by Jacqueline LaPointe

Just 16 percent of 2,000 hospitals reviewed as part of PatientsRightsAdvocate.org’s Semi-Annual Hospital Price Transparency Report are complying with the regulation requiring all hospitals...

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