Hospital Price Transparency: New CMS Enforcement Measures, Increased Penalties, and Ensuring Compliance

Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
Intermediate
- work Practice Area
Health
- event Date
Tuesday, July 25, 2023
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
-
This 90-minute webinar is eligible in most states for 1.5 CLE credits.
This CLE course will guide healthcare counsel on the hospital price transparency rule and CMS' new enforcement measures. The panel will examine the rule, its requirements, and the implications of the enhanced enforcement. The panel will also discuss the rule's impact on a hospital's relationship with insurers and patients and offer best practices for compliance.
Faculty

Ms. Shalom focuses on counseling clients in the health care, pharmacy, and medical device industries with respect to a wide range of regulatory and compliance matters. Her experience includes advising clients on Medicare and Medicaid reimbursement; internal investigations; managed care and value based payment arrangements; self-disclosures; federal and state fraud and abuse compliance; and state licensure issues. She also assists health care clients with a broad range of transactional matters, including mergers and acquisitions and formation of friendly professional corporations.

Ms. Worthen provides legal and strategic advice to hospitals, health systems, physician practices, and behavioral health providers, as well as post-acute care and other ancillary providers. She has broad experience working on matters pertaining to Medicare reimbursement, participation in CMS Innovation Center payment models, managed care contract negotiations, and value-based payment arrangements with insurance companies, self-insured employers, and Medicare Advantage plans. She also provides counsel on the regulatory, operational, and financial considerations necessary to navigate the evolving payment landscape, including the various components of risk, ranging from pay for quality, to shared risk, and ultimately to full risk. Ms. Worthen also addresses privacy and security issues under HIPAA and the Part 2 regulations and assists providers with payment disputes under their managed care contracts.

Ms. Hoffmann serves clients in the healthcare industry on an array of regulatory, operational, and transactional matters. She regularly assists hospitals, healthcare systems, and other provider types with mergers and acquisitions, particularly in connection with the complex licensure and regulatory questions that can arise in the context of a transaction. Ms. Hoffmann also advises healthcare clients on Medicare and Medicaid certification, compliance, and payment matters, as well as out-of-network balance billing laws and other issues affecting provider payment. She has experience helping clients with a variety of state and federal regulatory requirements, including facility licensure and the certificate of need application process. Ms. Hoffmann is an adjunct professor at Belmont University College of Law, where she teaches Biomedical Ethics.
Description
CMS' hospital transparency rule went into effect in 2021, but many hospitals disregarded the rule. Recently, CMS announced it has tightened enforcement of the rule. Under the new enforcement measures, CMS will require hospitals that violate the transparency rule to comply with all terms of a corrective action plan (CAP) within 90 days of CMS' request. Hospitals still must submit a CAP within 45 days from when CMS requests it.
Hospitals that fail to comply with the transparency requirements will face civil monetary penalties (CMPs) and publication of these penalties on the CMS website. Under the new enforcement measure, CMS will now impose automatic CMPs on hospitals that fail to comply with the CAP deadlines. If a hospital meets one but not both CAP deadlines, CMS will review the hospital's files to determine if there are violations. Those violations would be subject to an automatic CMP. Healthcare counsel should consider the legal and other risks as they work with hospitals to comply with the transparency rule.
Listen as our authoritative panel examines the hospital price transparency rule and CMS' new enforcement measures. The panel will discuss the rule, its requirements, and the implications of the enhanced enforcement. The panel will discuss the rule's impact on a hospital's relationship with insurers and patients and will offer best practices for compliance with the rule.
Outline
- Hospital price transparency rule
- Requirements
- Items and services
- New HHS enforcement measures
- Antitrust considerations
- Compliance best practices
Benefits
The panel will review these and other essential questions:
- What do the new enforcement measures mean for hospitals?
- What impact does the rule have on other legal obligations?
- What best practices should hospitals employ to ensure compliance with the price transparency rule?
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