Ep. 52 – Prioritize Hospital Price Transparency Compliance

On February 25, 2025, President Trump signed an Executive Order directing federal agencies to “rapidly implement and enforce” federal healthcare price transparency regulations. According to the Executive Order, within 90 days, or by May 26, 2025, the agencies are to:

• Require the disclosure of the actual prices of items and services, not estimates; 
• Issue updated guidance or proposed regulatory action ensuring pricing information is standardized and easily comparable across hospitals and health plans; and
• Issue guidance or proposed regulatory action updating enforcement policies designed to ensure compliance with the transparent reporting of complete, accurate, and meaningful data.

The Executive Order comes after oversight agencies and patient advocacy groups have alleged that a significant percentage of the nation’s hospitals are not fully compliant with the price transparency rules. For example, in November 2024, the Office of Inspector General for Health & Human Services issued a report estimating that 46% of hospitals were not fully compliant with the requirements.

Because federal agencies are now specifically directed to “rapidly implement and enforce” the price transparency rules, now is the time for hospitals to evaluate their compliance with the requirements and correct any issues. On the podcast this week, we discuss how to prioritize price transparency compliance over the next three months to prepare for increased enforcement efforts.

Overview of Price Transparency Requirements

The current regulations require hospitals to publish on their websites two types of price data: (a) a comprehensive list of all standard charges for all items and services they offer in a machine-readable file; and (b) a list of 300 shoppable services, 70 of which are dictated by CMS, in a consumer-friendly format. 

Comprehensive List

The comprehensive list of standard charges must include a description of each item and service, including whether it is provided in an inpatient or outpatient setting, as well as the following for each item and service:

• Any billing codes used for billing the item or service, including modifiers;
• Gross charge;
• Discounted cash price;
• Payer-specific negotiated charge, including the name of the third-party payer and specific plan, which may be indicated as categories (e.g. HMO, PPO);
• Methodology used to establish the charge, such as fee schedule, percentage of charges, algorithm, or case rate;
• When the charge cannot be expressed in a specific dollar amount, such as when based on an algorithm, an “estimated allowed amount” (which should be established based on the average charge paid by the payer);
• De-identified minimum negotiated charge;
• De-identified maximum negotiated charge; and
• For drugs, the unit of measurement and type of measurement.

The regulations require the machine-readable file to conform to a specific CMS template layout, data specifications, and data dictionary so that consumers can more easily compare information across hospitals. The machine-readable file must also contain the hospital name, license number, location name(s) and address(es), the version of the CMS template used for the file, and the date of the most recent update of the file.  

Shoppable Services

The second file a hospital must maintain is a list of 300 shoppable services, 70 of which are dictated by CMS. “Shoppable” services are healthcare services that can be scheduled by a patient in advance. If the hospital doesn’t provide one of the 70 services dictated by CMS to be included, it must specify that in the file. If the hospital doesn’t provide 300 shoppable services, it must provide the data for as many shoppable services as it provides. The hospital must include the same price-specific information as outlined above in the comprehensive file, including description, the payer-specific negotiated charge by third-party payer and plan, the discounted cash price, and the minimum and maximum negotiated charges. The hospital, however, can choose the format in which it displays the information.

Hospitals can meet the requirement to publish shoppable services data if they maintain an internet-based price estimator tool that meets the following:

• Provides estimates for at least 300 shoppable services, including the 70 CMS-specified shoppable services;
• Allows consumers to, at the time they use the tool, obtain an estimate of the amount they will be obligated to pay the hospital for the shoppable service based on their third-party payer and plan; and
• Is prominently displayed on the hospital’s website and accessible free of charge without having to register or establish an account or password.

Location & Accessibility

To ensure the price information is easily located by consumers, hospitals must make the above price information for their comprehensive list and shoppable services available in a clearly identified and prominent manner on their publicly available websites. Individuals must be able to access the information free of charge, without having to create an account or username, and without having to submit personally identifiable information. The files must also be searchable by service description, billing code, and payer.

The machine-readable file with the hospital’s comprehensive list of items and services  must also be located in a .txt file in the website’s root folder which:

• Includes the hospital location name that corresponds to the file, the source page URL that hosts the machine-readable file, and a direct link to the machine-readable file URL;
• Is accessible to automated searches and direct file downloads; and
• Includes hospital point of contact information.

Hospitals must also place a link in the footer of their websites, including on the homepage, which is labeled “Price Transparency” and links directly to the publicly available web page that hosts the link to the machine-readable file. 

Additional Requirements 

Each hospital must attest that to the best of its knowledge and belief, the information in the files is true, accurate, and complete as of the date indicated in the file. The files must be updated at least annually.

Check out this week’s podcast for tips on how to ensure you’re appropriately complying with the current rules and prepared for increased enforcement.