EDITOR’S NOTE:
Jory Hatton, CEO for ClaraPrice, concludes his exclusive, three-part series for RACmonitor on the CMS Hospital Price Transparency rule.
Avoiding a CMS (Centers for Medicare & Medicaid Services) hospital price transparency audit involves ensuring compliance with CMS regulations regarding the federal transparency requirements. Here are some steps you can take to minimize the risk of being audited or penalized:
Familiarize yourself with the CMS requirements for hospital price transparency. These requirements, which have been expanded in 2024, include creating and posting a consumer-friendly list of shoppable services, preferably avoiding Excel or CSV, and publishing a comprehensive machine-readable file in a CMS-defined data template. Hospitals must use the CMS template in JSON or CSV format by July 1, 2024.
Ensure that your hospital has implemented all necessary changes to comply with CMS regulations. This involves updating your website to include the cms-hpt.txt file required Jan. 1, 2024, placing links in the website header and footer, and updating all the necessary pricing information.
Review your hospital’s price transparency compliance regularly. We suggest quarterly meetings to review all state and federal price transparency requirements to identify potential areas of non-compliance. This process may involve conducting internal audits or assessments to ensure that all required pricing information is provided accurately and routinely.
Keep detailed records of your hospital’s price transparency compliance efforts, including any changes to your website or internal processes, to ensure compliance with the evolving regulations. If your hospital uses a vendor to manage your price transparency compliance, ensure that they do this for you. This documentation can be valuable in the event of an audit, demonstrating your hospital’s commitment to compliance. ClaraPrice, a team of hospital price transparency compliance experts, provides an administrative dashboard for hospital clients, allowing access to valuable analytics tools and a detailed data trail for historical purposes.
Stay informed about any updates or changes to CMS regulations regarding price transparency. This may involve monitoring CMS price transparency guidance documents, participating in the Outpatient Prospective Payment System (OPPS) proposed rule comment period, and attending training sessions or webinars that CMS provides. Consider also creating a free GitHub account to monitor the technical implementation of new price transparency requirements, including the most recent version of the CMS machine-readable file. Users can follow the evolution of upcoming requirements, participate in group conversations, and contribute to improving the architecture of future data files and formats.
If your hospital is audited or identified as non-compliant with CMS regulations, promptly address any issues. This may involve researching the current requirements, updating your website, contacting outside experts, revising internal processes, or providing additional training to staff to ensure ongoing compliance. You will want to avoid CMS enforcement actions, which are routinely updated and revised, at all costs.
If you have concerns about your hospital’s compliance with CMS regulations or the potential for a price transparency audit, consider advice from a compliance expert. By taking these steps, you can help minimize the risk of such an audit and demonstrate your hospital’s commitment to compliance with regulatory requirements.
Federal officials announced this week that one of the nation’s largest health insurers has agreed to pay $117.7 million to resolve fraud allegations. The False
The Centers for Medicare & Medicaid Services’ (CMS’s) $50 billion Rural Health Transformation Program was designed by the Trump Administration to reshape healthcare delivery in
Please log in to your account to comment on this article.
Uncover essential coding insights with nationally recognized coding authority Kay Piper, RHIA, CDIP, CCS. Through ICD10monitor’s interactive, on‑demand webcast series, Kay walks you through the AHA’s 2026 ICD‑10‑CM/PCS Quarterly Coding Clinics, translating each update into practical, easy‑to‑apply guidance designed to sharpen precision, ensure compliance, and strengthen day‑to‑day decision‑making. Available shortly after each official release.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s fourth quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s third quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Uncover critical guidance on the ICD-10-CM/PCS code updates. Kay Piper reviews and explains ICD-10-CM/PCS coding guidelines in the AHA’s second quarter 2026 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
Federal auditors are intensifying their focus on inpatient psychiatric facilities, using advanced data analytics to spotlight outliers and pursue high‑dollar repayments. In this high‑impact webcast, Michael Calahan, PA, MBA, Compliance Officer and V.P., Hospital & Physician Compliance, breaks down what regulators are really targeting in IPF-PPS admissions, documentation, treatment and discharge planning. Attendees will learn practical steps to tighten processes, avoid common audit triggers and protect reimbursement and reduce the risk of multimillion-dollar repayment demands.
In this timely session, Stacey Shillito, CDIP, CPMA, CCS, CCS-P, CPEDC, COPC, breaks down the complexities of Medical Decision Making (MDM) documentation so providers can confidently capture the true complexity of their care. Attendees will learn practical, efficient strategies to ensure documentation aligns with current E/M guidelines, supports accurate coding, and reduces audit risk, all without adding to charting time.
Join Ronald Hirsch, MD, FACP, CHCQM for The PEPPER Returns – Risk and Opportunity at Your Fingertips, a practical webcast that demystifies the PEPPER and shows you how to turn complex claims data into actionable insights. Dr. Hirsch will explain how to interpret key measures, identify compliance risks, uncover missed revenue opportunities, and understand new updates in the PEPPER, all to help your organization stay ahead of audits and use this powerful data proactively.
Stay ahead of the 2026-2027 audit surge with “Top 10 Audit Targets for 2026-2027 for Hospitals & Physicians: Protect Your Revenue,” a high-impact webcast led by Michael Calahan, PA, MBA. This concise session gives hospitals and physicians clear insight into the most likely federal audit targets, such as E/M services, split/shared and critical care, observation and admissions, device credits, and Two-Midnight Rule changes, and shows how to tighten documentation, coding, and internal processes to reduce denials, recoupments, and penalties. Attendees walk away with practical best practices to protect revenue, strengthen compliance, and better prepare their teams for inevitable audits.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 1 with code CYBER25
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
