AI That Supports Your Price Transparency Implementation

The CMS Hospital Price Transparency rule requires hospitals to publicly disclose their standard charges, including negotiated rates with payers for services. This rule aims to provide patients with clear and accessible information about healthcare costs.

Hospitals must conform their Machine-Readable Files (MRFs) to the CMS template layout by July 1st, 2024. Full compliance, including additional elements like estimated allowed amounts and detailed drug information, is required by January 1st, 2025.

Non-compliance can result in substantial penalties. Smaller hospitals (30 or fewer beds) could be fined $300 per day, while larger hospitals are subject to $10 per bed per day, with a maximum of $5,500 daily. This can total up to $2,007,500 per year. CMS also publishes the names of non-compliant hospitals, which can damage their reputation.

Benchmarking negotiated rates helps provider organizations optimize their pricing strategies, increase financial margins, and improve operational efficiency. By analyzing market comparisons, hospitals can identify opportunities to enhance revenue and streamline operations.

PayerAnalytics provides a comprehensive solution that simplifies compliance with the CMS Hospital Price Transparency rule. Our platform helps hospitals publish the required data in machine-readable formats and ensures all regulatory requirements are met efficiently. Additionally, PayerAnalytics leverages data published under the CMS Transparency in Coverage Rule to support hospitals in benchmarking their negotiated rates and optimizing their pricing strategies.

Contact us to schedule a demo and see how PayerAnalytics can work for you. Our team will guide you through the process and help you navigate the CMS mandates efficiently.