Public Comment Process – Critical to Price Transparency Regulations

Will Industry Comments on Price Transparency Make a Difference?

As we await CMS’ review and finalization of the 2020 expanded price transparency publication requirements many of us question whether the industry’s comments will be seriously considered.

Lots of Comments

On September 25th, only days before the public comment deadline, there were only 762 comments posted on Federal Register public comment site. That count grew to 1041 comments (as seen on the electronic submission website) by the submission deadline. It’s obvious that there is no lack of interest in the rule, as there have been 38,454 page views of proposed regulations as of 09/29/19.

In scanning the comment submissions, we see very strong public support for the price transparency mandates within the Proposed Rule. We have also read some very well-articulated letters from industry experts and several hospital associations. Unfortunately, the volume of responses from industry insiders is relatively limited which is both discouraging and concerning.

In a Price Transparency listening session several months ago, CMS specifically asked for documented input from providers to understand their challenges. Without hearing sufficient feedback on the technical challenges of gathering and reporting the expanded data we expect CMS may simply move forward with incorrect assumptions.

What did CMS Need to Hear?

Since the price transparency mandates have been largely pushed out as regulatory requirements rather than collaboratively-developed with the hospital industry, the Public Comment process is a critical way to share information. Even during the CMS Listening Session on price transparency the agency staffers spent the majority of the allocated time simply presenting its proposed guidance leaving under 30 minutes for public input.

What the Industry Said –

Hospital experts who did comment on the Rule expressed concern that CMS needed input on ‘how things work’ relative to: Chargemaster structure, hospital information systems data files/functions, pricing methodologies, and payer contract terms. At least with that input, CMS may better-understand why some of its proposed requirements are viewed by industry experts as unreasonable.

Our own comments ( were focused on what we believe were grossly-underestimated time-estimates for implementing the expanded requirements.

Several commenters suggested consistency with the definitions of key terms in the new regulations to avoid misinterpretations or conflict with existing standards. We agree, and noted that as well in the CMS listening session.

Finally, one organization effectively noted Federal Trade Commission and Department of Justice guidance relative to the impact of negotiated rate publication. Legal concerns as well as concerns about the risk of price inflation are outlined.

What the Public Said –

Unfortunately, despite some very well-written industry comment letters, the majority of comments are from critics of hospital pricing. And to be honest, who can argue with the public’s perception? Much public relations damage has already been done: A decade of news stories, and the current tone and timelines of Price Transparency mandates (both in the Presidential Order in CMS’ Proposed Rule language have perpetuated the impression that hospitals are secretive and predatory in their price practices.

In our view, the small volume of industry comments will do little to correct misconceptions about charge structure and information systems functionality. It’s likely any push-back from the industry will be perceived by the public as simply “protecting secrets”.

Let’s be Realistic about Hospital Prices

No one can dispute that the healthcare market is facing a revolution against its historic pricing practices. Comparison pricing and percentage increases without consideration of true cost can’t continue. With higher out of pocket plans exacerbated by the growing healthcare needs of baby boomers, there will continue to be public relations backlash until rates are perceived as consistent and reasonable across settings.

However, we believe that the most effective transparency measures require a collaborative, not hard-fisted, approach using a phased-in method that is actually workable. We’ll see if that may happen as CMS finalizes its rulemaking, but it is doubtful.

Prepare now for Expanded Price Transparency Mandates

Over the coming 6-8 weeks, consider what CMS has proposed and how your organization will comply. Ask your team the following questions:

  • Did we accurately fulfill the 2019 mandates on price transparency?
  • How is the current publication of pricing information affecting community and patient relations?
  • Do we have reasonable methods of providing out of pocket estimates?
  • Is there a process in place to address pricing complaints?
  • Are our charges defensible as compared to cost, other comparable providers, or retail competitors?
  • Is the Chargemaster erroneous or outdated?
  • Does our team have a plan for effectively performing 1/1/20 CDM data updates relative to coding and payment system changes?
  • Do we have a methodology and committee structure to plan for expanded pricing publication requirements?

Don’t wait until November to ask these important questions. Contact our office at if you’d like to talk about how we’re helping other hospitals with the increasing requirements of CMS Price Transparency.

Holliday & Associates offers ChargeAssist®; an HFMA Peer Reviewed™ Charge Master auditing and resource tool for easily auditing, collaborating, and maintaining Charge Master files. We also provide Charge Management Team and Charge Master Coordinator Educational Programs as well as customized CDM Reviews by a team of credentialed clinical, coding and technical auditors.

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