New Rule on Hospital Transparency Effective January 2021

On Friday, November 15, 2019, the Trump administration released its final rule regarding hospital price transparency, which will take effect in 2021.

What does this new rule mean?

Hospitals will now be required to provide easily accessible billing information to patients. This means having all standard charges available online and living in one single data file. According to a Centers for Medicare and Medicaid Services (CMS) press release, the data file needs to be readable by other computer systems. 

“…we are throwing open the shutters and bringing to light the price of care for American consumers.” — CMS Administrator Seema Verma

The charges that will be available online will include:

  • Gross charges,
  • Payer specific negotiated charges,
  • Amount the hospital is willing to accept from a patient (via cash),
  • And the minimum and maximum negotiated charges.

As part of the rule, CMS has been granted more authority over enforcement, meaning the department will now have greater capability to audit hospitals and issue fines of $300 per day to those who are non-compliant.

Over the past four months, CMS has been collecting feedback on a proposed version of the rule. Now, a year later than originally proposed, the rule will become effective January 1, 2021. Until then, hospitals will be working to make the applicable data available online, if they haven’t done so already.

To download this information, click here.


Questions? Contact the Creative Benefits Team at 866-306-0200.