Achieving Hospital Price Transparency for Compliance, Patients

Achieving Hospital Price Transparency for Compliance, Patients

A CMS price transparency rule imposed requirements on hospitals to publicize their pricing data. The rule lays out how hospitals can achieve price transparency in a regulatory sense, which is important as CMS amps up enforcement of the rule's requirements. However, hospital price transparency also needs to go beyond regulatory compliance so consumers can truly shop for care.Hospitals have a long journey to price transparency, considering lackluster regulatory compliance rates, according to several reports and trackers. Most hospitals are not fully compliant with the overall CMS price transparency rule, with many missing the part of many of the technical aspects of the rule. Fully complying with the rule's requirements, though, is key to avoiding enforcement actions, such as civil monetary penalties.

Medigy Insights

The CMS price transparency rule's requirements for hospitals have undergone several iterations since the rule went into effect in 2021. Many of the changes that went into effect at the start of 2025 involved technical aspects of posting pricing data in the MRF. However, these requirements are trickier to comply with than they may seem, according to Joe Wisniewski, assistant vice president of channel partnerships at Turquoise Health.For example, hospitals must not post estimated allowed amounts, or the average dollar amount a hospital has historically received from a third-party payer. To do this, hospitals will need to parse through their 835 and 837 files to find the prices.


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