Effective January 1, 2019, The Affordable Care Act has required each hospital to publish, update, and make public a list of its standard charges for items and services provided by each hospital; this includes diagnosis related groups (DRGs). In CMS’ 2019 Proposed Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals (IPPS) Rule  and 2019 Final Hospital Inpatient Prospective  Payment Systems for Acute Care Hospitals (IPPS) Rule  they provided more specific guidance to hospitals creating access to their publicly available chargemasters. The agency feels that there is considerable confusion for consumers regarding the cost of services within the hospital, and the publication of accessible information is a step towards reducing this confusion and promoting price transparency.

According to the 2019 IPPS Final Rule, beginning January 1, 2019, hospitals will be required to:

• Make a list of their current standard charges publicly available online
• Update at least annually, or more as necessary
• List standard charges in a “machine readable” format

Although not a final or proposed rule. in November 2018, CMS posted a FAQ providing further clarification. In their FAQ, CMS interpreted:

• “Machine readable format” as a digitally accessible document easily imported/read into a computer system (e.g., XML, CSV), rather than a PDF
• Hospitals are required to either make public a list of their standard charges (whether that be the chargemaster itself or in another form of their choice) or their policies for allowing the public to view a list of those charges in response to an inquiry

Also, in the 2019 IPPS Proposed Rule, CMS sought comment on other price transparency efforts including:

• Definition of standard charges
• Type of information that would be most beneficial to patients
• Whether providers should be required to inform patients of out-of-pocket costs before services are furnished
• Requirement that providers give patients information about Medicare payment for a service
• The impact of Medigap coverage on patient understanding of out-of-pocket costs

In the 2019 IPPS Final Rule, CMS summarized comments received on these aforementioned topics, however, none of these topics were finalized for a January 1, 2019 implementation. It is possible that these considerations will be considered for inclusion in subsequent years.