Recent fines issued by the Centers for Medicare & Medicaid Services (CMS) have brought price transparency compliance into sharp focus.
With two additional hospitals collectively fined over $400,000 for violations spanning hundreds of days, it’s clear that non-compliance is no longer an option for healthcare providers.
These fines are part of CMS’s continued efforts to promote transparency for the benefit of patients, underscoring the urgent need for organizations to meet regulatory standards.
CMS has significantly ramped up its price transparency enforcement efforts in recent years, as evidenced by its increasing audit frequency—from 30-40 reviews per month to over 200.
Additionally, updated guidance requires hospitals to move away from estimated costs in favor of the actual prices of services.
To date, CMS has issued fines to 27 hospitals, with 10 of those occurring in 2025 alone. Hospitals out of compliance not only face hefty penalties but may also tarnish their reputation and disrupt patient trust in their services. CMS’s stricter stance makes one thing abundantly clear—healthcare organizations must prioritize compliance.
Price transparency regulations exist to empower patients to view readily accessible information about healthcare costs. Reinforced in an executive order issued during the initial Trump administration and promulgated through the Affordable Care Act (ACA), these rules require hospitals to disclose the actual prices for items and services—not estimates.
Compliance for hospitals involve:
Hospitals should perform regular audits to ensure data accuracy and adherence to CMS standards. This patient-first approach aims to provide a better understanding of healthcare prices, help mitigate surprise billing, enhance financial planning for healthcare costs, and build trust between patients and providers.
Failure to comply with price transparency regulations exposes organizations to wide-ranging risks, including:
1. Financial Penalties
Non-compliance fines are coming in at hundreds of thousands of dollars, and can range into the millions, posing a significant financial strain on healthcare facilities, particularly smaller or rural hospitals. Over time, these losses can compromise growth and strategic investments.
2. Reputational Damage
Transparency is essential for maintaining public trust. Non-compliance can foster a perception of opaque practices, deterring patients and negatively impacting an organization’s reputation in a highly competitive healthcare market. Hospitals can also end up on the aforementioned CMS sanction list, which is a scar that can remain for perpetuity.
3. Operational Disruptions
Outdated processes or inconsistent strategies can lead to inefficiencies, wasted resources and disruptions in workflows. These inefficiencies increase risk for non-compliance, divert valuable time and focus from patient financial clearance.
4. Strained Partnerships
Non-compliance can hinder collaboration with payers, whether through contract negotiations or reimbursement discussions. Healthcare organizations with a transparent approach have a far stronger foundation for payer relations.
To help mitigate compliance risks with CMS mandates, providers should adopt an organized and proactive approach.
Below are critical steps for a strong path to sustained compliance:
1. Dedicated Price Transparency Teams
Establish a specialized team to handle compliance efforts, from monitoring pricing updates to reviewing policy changes. Regularly schedule meetings to ensure alignment with regulatory updates.
2. User-Friendly Pricing Information
Make costs accessible and understandable for patients, following the CMS guidelines and formats. CMS mandates that hospitals post machine-readable files and do so in patient-friendly ways. Mobile responsiveness and intuitive navigation are critical.
3. Accurate Pricing Estimates
Provide detailed cost estimates for procedures, considering factors like insurance coverage and patient-specific variations. Transparency and consistency in estimates help mitigate surprises with billing and also builds trust with the patient.
4. Regular Audits
Perform frequent evaluations to identify gaps or inconsistencies in your procedural pricing workflows and systems. Combining internal audits with third-party reviews ensures thorough and unbiased compliance checks.
5. Staff Training
Conduct targeted training programs to ensure all staff members understand the transparency laws and their roles in maintaining compliance. This applies across administrative, front-line and managerial teams.
6. Automation and Technology
Leverage advanced platforms to automate data validation, consolidate pricing information and mitigate compliance issues with the CMS regulations. Automation reduces manual errors and streamlines workflows.
Healthcare price transparency goes beyond regulatory compliance. It’s a foundation for building trust, empowering patients and differentiating healthcare providers in a crowded market. Hospitals willing to invest in proactive compliance strategies position themselves as leaders in revenue cycle and best in class patient financial clearance.
Now’s the time for organizations to act. Complacency is not an option – although these rules have been in place for some time, the heat is on from the regulators. CMS enforcement shows no signs of slowing down and the penalties for non-compliance go beyond finances, risking reputational and operational stability.
For a seamless compliance mitigation process and improved patient trust, explore how FinThrive can transform price transparency in your organization.
Start your compliance strategy with FinThrive today.
*Disclaimer: This article is provided for informational purposes only and does not constitute legal advice. The content discusses regulations and compliance matters but should not be relied upon as a substitute for professional legal counsel.