Fix Time
1 hour
Accumulated Liability
$167,750
Daily Penalty
$2,750/day
Status
open
Regulation
45 CFR § 180.50(c)(1) →
Standard charges must be associated with billing and accounting codes.
What's Wrong?
Procedure codes (CPT, HCPCS, DRG) are formatted inconsistently or use non-standard codes.
How to Fix
Owner: revenue cycle • Estimated time: 1 hour
1
Export your current billing codes
Generate a list of all procedure codes (CPT, HCPCS, DRG, NDC) from your machine-readable file.
2
Identify formatting issues
Look for: missing leading zeros, inconsistent delimiters (CPT 99213 vs 99213), mixed code types in same field.
Example:
Correct: "99213" | Incorrect: "99213-Office Visit" or "99213 (Office Visit)"3
Standardize code format
Apply consistent formatting: CPT codes (5 digits, no hyphens), HCPCS (letter + 4 digits), DRGs (3 digits).
4
Validate against code sets
Cross-reference codes against current AMA CPT, CMS HCPCS, and CMS DRG code sets to ensure validity.
5
Update and re-publish file
Apply the standardized codes to your MRF and upload the corrected version.
Evidence
{
"invalid_codes": [
"99213-Office Visit",
"70450 (CT Scan)"
],
"expected_format": "99213",
"file_url": "https://stmarysregional.org/price-transparency/standard-charges.json"
}Estimated violation age: 61 days