CMS Hospital Price Transparency 2021:

(1)

Contact (844)-336-2244 chandra@zeamedhealth.com 6395, Halcyon Garden Dr, Alpharetta, GA 30005 zeatool.com zeamed.com

Analysis of Southeast Region of the United States

CMS Hospital

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The Centers for Medicare & Medicaid Services (CMS) issued a Price Transparency Mandate, which requires six thousand hospitals in the US to publish their standard charges in a machine-readable format and a consumer-friendly manner on their websites by January 1, 2021. The requirement is the first step to taking complex healthcare pricing information and making it transparent.

1

2

Southeast Region

Comprehensive file with all items, services, and service packages which include:

• Gross charges

• Discounted cash prices

• Payer-specific negotiated charges

• De-identified minimum negotiated charges • De-identified maximum negotiated charges

A consumer-friendly display that includes the following standard charges for at least 300 ‘shoppable’ services:

• Discounted cash prices

(use gross charges if cash prices are not available) • Payer-specific negotiated charges,

• De-identified minimum negotiated charges • De-identified maximum negotiated charges

According to CMS, the machine-readable file should include the following:

(3)

Hospitals can use a patient estimator tool instead of

‘shoppable’ services.

OR

We have analyzed more than 5000 hospital data across the United States to see if they are compliant with CMS requirements and simplified the data into a user-friendly format so that anyone can easily understand.

Providers have defined their own column/field names. MR files were available in

CSV, EXCEL, JSON, XML, PDF, DOCX, HTML, and Text. Some MR files had only billing

IDs, and some gave service descriptions without code types like CPT, MS-DRG,

APR-DRG, APC, HCPCS, NDC, Internal Codes. Most of the providers have not

mentioned if the price includes all ancillary services.

We want to help hospitals that are non-compliant to become compliant using our price transparency Zeatool. Our goal is to help hospitals take this big pricing data, navigate new ways to cut waste, increase revenue, and bring the

antiquated healthcare system into the E-commerce age. Once healthcare data is shoppable, consumers can better understand their healthcare costs before receiving treatment and avoid surprise bills. This pricing information is highly beneficial for uninsured & underinsured consumers and self-insured employers to price shop healthcare services.

We started with the Southeastern region, followed by the Southwest, Northeast, Midwest, West, and other areas, including Puerto Rico, Virgin Islands, and Washington DC.

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We analyzed 1,334 hospitals in the Southeast Region and found 449 (34%) are compliant, and 885 (66%) are non-compliant with CMS requirements. As of March 26, 2021, the non-compliant hospitals will face a penalty of $300/day for a total of 22.30M, and penalty for each non-compliant hospital is $25,200.

Hospitals Compliant Non-Compliant

1334

34%

66%

Southeast Region

Total

Hospitals Compliant NonCompliant Charge Master(MR File) Shoppable Services(MR File) Estimator Tool

Available Not Available Available Not Available Available Not Available

1334 449 885 1163 171 178 1156 919 415

Possible Penalty (as of Today)

$22,567,500

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We analyzed 126 hospitals in Alabama. 53 (42%) hospitals are compliant, and 73 (58%) hospitals are non-compliant as per CMS price transparency guidelines. The 73 non-compliant hospitals will face a penalty of $1.86M in total.

126 42%

58%

Alabama

Total

126 53 73 103 23 23 103 66 60

$1,861,500

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We analyzed 85 hospitals in Arkansas. Out of those, 36 (42%) hospitals are compliant, and 49 (58%) hospitals are non-compliant as per CMS price

transparency guidelines. The 49 non-compliant hospitals will face a penalty of $1.25M in total.

85 42%

58%

Arkansas

Total

85 36 49 65 20 10 75 57 28

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We analyzed 207 hospitals in Florida. Out of those, 52 (25%) hospitals are compliant, and 155 (75%) hospitals are non-compliant as per CMS price

transparency guidelines. The 155 non-compliant hospitals will face a penalty of $3.95M in total.

207 25%

75%

Florida

Total

207 52 155 197 10 18 189 155 52

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We analyzed 142 hospitals in Georgia. 44 (31%) hospitals are compliant, and 98(69%) hospitals are non-compliant as per CMS price transparency guidelines. The 155 non-compliant hospitals will face a penalty of $2.50M in total.

142 31%

69%

Georgia

Total

142 44 98 132 10 31 111 102 40

$2,499,000

03/26/2021 03/26/2021

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We analyzed 102 hospitals in Kentucky. 31 (30%) hospitals are compliant, and 71(70%) hospitals are non-compliant as per CMS price transparency guidelines. The 102 non-compliant hospitals will face a penalty of $1.81M in total.

102 30%

70%

Kentucky

Total

102 31 71 94 8 17 85 67 35

$1,810,500

03/26/2021 03/26/2021

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We analyzed 144 hospitals in Louisiana. 42 (29%) hospitals are compliant, and 102(71%) hospitals are non-compliant as per CMS price transparency guidelines. The 144 non-compliant hospitals will face a penalty of $2.60M in total.

144 29%

71%

Louisiana

Total

144 42 102 114 30 26 118 84 60

$2,601,000

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We analyzed 96 hospitals in Mississippi. 47 (49%) hospitals are compliant, and 49(51%) hospitals are non-compliant as per CMS price transparency guidelines. The 96 non-compliant hospitals will face a penalty of 1.25M in total.

96 49%

51%

Mississippi

Total

96 47 49 75 21 17 79 67 29

$1,249,500

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We analyzed 112 hospitals in North Carolina. 29 (26%) hospitals are compliant, and 83(74%) hospitals are non-compliant as per CMS price transparency guidelines. The 112 non-compliant hospitals will face a penalty of $2.12M in total.

112 26%

74%

North Carolina

Total

112 29 83 103 9 8 104 81 31

$2,116,500

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We analyzed 67 hospitals in South Carolina. 18 (27%) hospitals are compliant, and 49(73%) hospitals are non-compliant as per CMS price transparency guidelines. The 67 non-compliant hospitals will face a penalty of $1.25M in total.

67 27%

73%

South Carolina

Total

67 18 49 62 5 8 59 46 21

$1,249,500

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We analyzed 113 hospitals in Tennessee. 59 (52%) hospitals are compliant, and 54(48%) hospitals are non-compliant as per CMS price transparency guidelines. The 113 non-compliant hospitals will face a penalty of $1.38M in total.

113 52%

48%

Tennessee

Total

113 59 54 100 13 14 99 79 34

$1,377,000

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We analyzed 87 hospitals in Virginia. 17 (20%) hospitals are compliant, and

70(80%) hospitals are non-compliant as per CMS price transparency guidelines. The 87 non-compliant hospitals will face a penalty of $1.78M in total.

87 20%

80%

Virginia

Total

87 17 70 71 16 3 84 80 7

$1,785,000

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We analyzed 53 hospitals in West Virginia. 21 (40%) hospitals are compliant, and 32 (60%) hospitals are non-compliant as per CMS price transparency guidelines. The 53 non-compliant hospitals will face a penalty of $$816.00K in total.

53 40%

60%

West Virginia

Total

53 21 32 47 6 3 50 35 18

$816,000

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• Northwest Medical Center- Winfield AL • Highlands Medical Center- Scottsboro- AL

• St. Claire Regional Medical Center- Morehead - KY • Murray-Calloway County Hospital -Murray- KY • Monroe County Medical Center- Tompkinsville- KY • Taylor Regional Hospital- Campbellsville- KY

• Rockcastle County Hospital- Mount Vernon - KY • Breckinridge Memorial Hospital- Hardinsburg- KY • Russell County Hospital- Russell Springs - KY • Franklin Foundation Hospital- Franklin- LA • Richland Parish Hospital Delhi- Delhi- LA

• Winston Medical Center and Swingbed- Louisville- MS • Simpson General Hospital CAH- Mendenhall- MS

The following thirteen hospitals have exceeded the CMS

requirements by giving Chargemaster MR file, Shoppable

Services MR file, and Estimator tools.

Contact

Dr. Chandra Bondugula _{(844)-336-2244}

Founder and CEO ZeaMedHealth chandra@zeamedhealth.com 6395, Halcyon Garden Dr, Alpharetta, GA 30005 zeatool.com zeamed.com