The Centers for Medicare & Medicaid Services (CMS) released updated guidance May 22 related to hospital price transparency requirements under Executive Order 14221, “Making America Healthy Again by Empowering Patients with Clear, Accurate and Actionable Healthcare Pricing Information”.
The new guidance introduces significant changes to existing reporting obligations. Hospitals are now required to include actual dollar amounts for all payer-specific standard charges in their machine-readable files (MRFs), including negotiated rates that were previously allowed to be expressed as percentages or algorithms.
Hospitals may no longer use placeholder values such as “999999999” for estimated allowed amounts. Instead, they must calculate and report the average dollar amount historically received for each item or service using data from electronic remittance advice (835 transactions) from the 12 months prior to the MRF’s posting. If insufficient data exists to calculate the average, hospitals must provide a reasonable estimate along with documentation explaining the methodology used in the MRF notes section.
The MHA encourages hospitals to review their current transparency policies and assess any gaps in their publicly available MRFs.
Members with questions may contact Jim Lee at the MHA