CMS Offers Up New Hospital Price Transparency Resources

CMS has published on its website new hospital price transparency resources to help hospitals meet the federal requirement to make certain standard charges available to the public via a machine-readable format.

The federal agency released three sample voluntary sample formats for posting the standard charges, which include gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. The sample formats are wide, tall, and plain. CMS also provided a sample data dictionary for the wall and tall formats.

Hospitals have been subject to the price transparency requirement since the start of last year. However, to date, compliance with the hospital price transparency rule has been inconsistent and spotty.

An October 2022 report from Turquoise Health showed that almost two-thirds of hospitals are complying with the price transparency requirement as of the third quarter of 2022. Compliance included publishing machine-readable files, which 76 percent of hospitals have now done. However, just 65 percent of hospitals have published machine-readable files with negotiated rates and 63 percent posted machine-readable files with cash rates.

Hospital price transparency compliance has come a long way since the requirement took effect in January 2021. A previous report from PatientsRightsAdvocate.org found that only 16 percent of some 2,000 hospitals analyzed were complying with the requirement earlier this year.

Failing to comply with the hospital price transparency requirement could cost hospitals. CMS is auditing hospitals to check for compliance and two hospitals have faced civil monetary penalties for lack of compliance.

Some stakeholders, however, feel CMS enforcement has not been enough to encourage full compliance. For example, the House Committee on Energy and Commerce urged the Government Accountability Office (GAO) earlier this month to investigate hospital price transparency compliance following continuous reports of hospital non-compliance. The key House committee specifically asked GAO to look into the extent hospitals have complied with the machine-readable file format requirements.

According to CMS, acceptable machine-readable formats include, but are not limited to, .XML, .JSON and .CSV formats. The wide and tall voluntary sample formats CMS recently published are in .CSV formats, while the plain sample is a machine-readable JSON schema.

The sample formats include the data elements hospitals must provide in order to comply with the price transparency requirement. CMS says on its website that the wide sample format has “variable payer and plan name data elements,” while the tall version has “static payer and plan data name elements.”