CMS releases tool to help hospitals with price transparency

CMS recently released a web-based validation tool that assists hospitals with price transparency compliance.

The updated V2.0 Online Validator Tool helps hospitals develop machine-readable files to comply with a federal price transparency regulation that went into effect in 2021. The regulation requires, among other obligations, hospitals to publicly post a machine-readable file containing standard charges for all services and items. The standard charges include gross charges, payer-specific negotiated rates, de-identified minimum and maximum negotiated rates and discounted cash prices.

Despite years of enactment, hospitals have made little progress with compliance. A recent report from PatientRightsAdvocate.org, which tracks hospital price transparency compliance semi-annually, only about a third of hospitals are fully compliant. To be fully compliant, hospitals must post the machine-readable file and provide a consumer-friendly list of prices for the 300 more common shoppable services, or offer a price estimator tool.

Notably, about 65.1% of the 2,000 hospitals analyzed in the report did not post a complete machine-readable file of standard charges. The report also found “widespread noncompliance of 65.5& of hospitals is due to files being incomplete or not having prices clearly associated with both payer and plan.”

Machine-readable files help consumers and researchers easily access hospital pricing information to make comparisons. The data can enable stakeholders to view price variations and make informed decisions about healthcare.

The V2.0 Validation Tool allows hospitals to test their machine-readable files against new format and data specifications that will go into effect later. If the uploaded file does not conform to CMS’ template layout or data specifications, the tool will let the hospital know there are “errors” and “warnings.” Errors represent noncompliance with requirements being enforced on July 1, 2024, while warnings represent noncompliance with requirements being enforced on January 1, 2025.

If hospitals have more than 250 errors, the Online Validator tool will stop reviewing the uploaded machine-readable file, CMS explains. It will also stop reviewing if an error is found in rows 1 through 3, which include errors in general data element headers, general data element values and standard charges, item or service, and coding headers.

CMS emphasizes that that validation tool helps to ensure compliance but does not certify that the machine-readable file fully complies with all requirements of the hospital price transparency regulation.

The tool’s webpage also says that CMS does not track individual hospitals’ use of the Online Validator. However, the agency may use the Validator to assess hospital compliance with the machine-readable file requirements if the hospital becomes subject to a compliance review.

Hospitals can upload their machine-readable files in either .json or .csv file formats.