CMS Price Transparency
Achieve and maintain compliance with the CMS Price Transparency mandates. To help you navigate the requirements, you will find links to each CMS mandate with supporting CMS materials, as well as our synopsis of each requirement.
Hyve Health is here to assist our customers achieve and maintain compliance with the CMS mandates listed below based on the products we offer. To help you navigate through the requirements, you will find links to each CMS mandate that our products address with supporting CMS materials, as well as our synopsis of each requirement.
The information presented is provided as guidance by Hyve Health and assumes no responsibility or liability for any errors or omissions in the content for CMS requirements. The information provided is on an "as is" basis with no guarantees of completeness, accuracy, usefulness or timeliness. It is expected each organization will conduct due diligence for CMS compliance.
CMS No Surprises Billing Act – Good Faith Estimate
CMS Hospital Price Transparency
Hyve Health Product: Insight CMS Price Transparency (MRF & 300 Shoppable)
Overview
The Hospital Price Transparency rule went into effect on January 1, 2021, with regular requirement updates. The most recent changes went into effect January 1, 2025.
https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency
The hospital price transparency requirements are codified in regulations at 45 CFR Part 180 and applies to facilities that meet the definition of hospital (defined at 45 CFR § 180.20) and that are not otherwise excepted (see 45 CFR § 180.30(b)). Hospitals must make public their standard charges online in two ways:
- A machine-readable file containing a list of all standard charges for all items and services as provided in § 180.50, and;
- A consumer-friendly list of standard charges for a limited set of shoppable services as provided in § 180.60.
Machine Readable File Requirements:
In the CY2024 OPPS/ASC Final Rule, CMS finalized a requirement for hospitals to adopt a CMS template and encode standard charge information for a subset of data elements by July 1, 2024, and all required data elements by January 1, 2025, as noted in the following tables:
CMS Template Required Data Elements and Enforcement Timeline
- MRF Information
- Hospital Information
- Standard Charges
- Item & Service Information
- Coding Information
MRF Accessibility
As of January 1, 2024, a hospital must ensure that its MRF is easily accessible by both the public and by CMS for automated auditing. The new requirements include a .txt file and website footer. A hospital’s good faith effort in providing access to its MRF is demonstrated through meeting these requirements together with the publishing of the MRF itself.
.txt file
This is different than your MRF file.
As finalized in the CY2024 OPPS/ASC Final Rule, beginning January 1, 2024, each hospital must ensure that the public website it selects to host its machine-readable file (MRF) establishes and maintains, in the form and manner specified by CMS:
- A TXT file in the root folder that includes:
- The hospital location name that corresponds to the MRF;
- The source page URL that hosts the MRF;
- A direct link to the MRF (the MRF URL); and
- Hospital point of contact information.
The purpose of these requirements is to facilitate automated access to hospital MRFs. Please refer to 45 CFR 180.50 (d)(6)and discussion at 88 FR 82111-82113. Frequently Asked Questions on the TXT File may be found here.
The .txt file must be placed in the root folder of the website domain that hosts the MRF. The .txt file is a document that provides information specific to the hospital location name, source page URL that hosts the MRF, a direct link to the MRF, and designated point of contact information. To assist hospitals in generating the MRF, CMS provides instructions and a generator tool for document output.
Example #1 TXT File
This TXT file example demonstrates a scenario in which a hospital has two locations (“Example Hospital East” and “Example Hospital West”), each with its own set of standard charges. Under the regulation, the hospital must maintain a separate MRF for each location. A single TXT file, hosted in the root folder of the hospital’s website, would include information for both locations and their corresponding MRFs as separate entries.
In this example, the hospital’s website hosts the directly downloadable links to the MRFs on the same source page, so the source page URL is the same for both entries. However, the MRF URL for each of the entries is unique.
Finally, in this example, the POC for the first MRF is a person (Jon Snow) that can be reached at jsnow@example.com.
Example #2 TXT File
This TXT file example demonstrates a scenario in which a hospital has two locations (“Sample Hospital” and “Sample Standalone Emergency Department”) that share the same set of standard charges. Under the regulation, it is permissible for the two locations to share a single MRF. A single TXT file would include information for both locations as separate entries and repeat the shared source page URL and MRF URL.
In this example, the hospital’s “vendor” hosts the single MRF for the hospital on the vendor’s website. The TXT file should indicate the vendor’s source page URL and the MRF URL established by the vendor for the MRF.
Finally, in this example, the POC for the file is a team of people (MRF Department) that share an email address (MRFteam@sample.com).
IMPORTANT: If your hospital is using Hyve Health’s hosting service to host the MRF, your .txt file should indicate our source page URL specific to your MRF.
Contact Name and Contact Email for .TXT File:
IMPORTANT: Contact name and email should be someone from your organization. Please do not list Hyve Health or a Hyve Health employee.
Website Footer
As finalized in the CY2024 OPPS/ASC Final Rule, beginning January 1, 2024, each hospital must ensure that the public website it selects to host its machine-readable file (MRF) establishes and maintains, in the form and manner specified by CMS.
The hospital must provide a link in the footer of its website that is labeled exactly: “Price Transparency.” Other variations, such as “Pricing Transparency” or “Hospital Price Transparency,” are not acceptable. The footer must link directly to the publicly available webpage that hosts the link to the MRF and your 300 Shoppable Services site.
Hyve Health recommends that your publicly available price transparency webpage on your hospital website where your website footer links to has clear language to guide your patients to your Machine Readable File.
Workflow Guidance to Ensure Compliancy with CMS if Using Hyve Health to Host MRF:
Shoppable Services
Beginning January 1, 2021, hospitals’ standard charges, including the rates they negotiate with insurance companies and the discounted price a hospital is willing to accept directly from a patient if paid in cash, must be publicly available, free of charge, and presented in a consumer-friendly display.
Display of at least 300 “shoppable services” (or as many as the hospital provides if less than 300) that a health care consumer can schedule in advance.
This is different than the MRF requirement which has ALL items and services provided by the hospital with specific additional information and formatting. See CMS Template Required Data Elements and Enforcement Timeline.
CMS identified 70 mandatory services to be included in “shoppable” services. The remaining 230 services may be selected by the hospital but must be services that are commonly provided to the hospital’s patient population and selected from the following categories of “shoppable” services: evaluation and management, laboratory and pathology, radiology and medicine/surgery services.
70 Mandatory Services:
CMS states that if a hospital does not provide some of the 70 CMS-specified services, then the hospital would identify enough shoppable services that it commonly provides to its unique patient population so that the total number of shoppable services is at least 300.
Shoppable Services Accessibility
Your hospital must post its consumer-friendly display of shoppable services prominently on a publicly available website, and the information displayed must clearly identify the hospital location with which the standard charges are associated.
Publicly available is defined by CMS as prominently displayed on the hospital's website and accessible to the public without charge and without having to register or establish a user account or password.
Hyve Health recommends that your publicly available price transparency webpage on your hospital website where your website footer links to has clear language to guide your patients to your 300 Shoppable Services site.
Website Footer
As finalized in the CY2024 OPPS/ASC Final Rule, beginning January 1, 2024, each hospital must ensure that the public website it selects to host its machine-readable file (MRF) and shoppable services establishes and maintains, in the form and manner specified by CMS.
The hospital must provide a link in the footer of its website that is labeled exactly: “Price Transparency.” Other variations, such as “Pricing Transparency” or “Hospital Price Transparency,” are not acceptable. The footer must link directly to the publicly available webpage that hosts the link to the MRF and your 300 Shoppable Services site.
Example:
CMS Links
- CMS Hospital Price Transparency https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency
- October 21, 2024 CMS Hospital Price Transparency: Encoding the January 1, 2025 Requirements in the Machine-Readable File & Tips for Implementation Webinar Materials (PDF)
https://www.cms.gov/files/document/cms-hpt-webinar-10-21-2024.pdf
- January 17, 2024 CMS Hospital Price Transparency Machine-Readable File Template Webinar Materials (PDF)
- Hospital Price Transparency Tools
https://cmsgov.github.io/hpt-tool/
- Hospital Price Transparency Validator FAQ
https://www.cms.gov/files/document/hospital-price-transparency-validator-faqs.pdf
- CY2024 OPPS/ASC Final Rule
- 70 Mandatory Shoppable Services
