President Donald Trump has pursued increased healthcare price transparency measures so far in his term through an executive order signed in February. Now, in alignment with that policy, CMS released updated proposals for price transparency July 15.
Here are five things to know about the new price transparency measures:
1. Beginning Jan. 1, 2026, hospitals will be required to disclose the 10th, median and 9-th percentile of allowed amounts in machine-readable files when payer-specific negotiated charges are based on percentages or algorithms in addition to the count of allowed amounts used to determine these percentiles. This policy aims to more accurately reflect the distribution of actual prices that the hospital has received for an item or service.
2. In order to enhance the comparability of hospital standard charges, hospitals will be required to use “electronic data interchange 835 electronic remittance advice transaction data to calculate and encode allowed amounts when a payer-specific negotiated charge is based on a percentage or algorithm.” Hospitals will also be required to comply with specific instructions regarding the methodology used to calculate percentiles.
3. Hospitals must attest that they have included all applicable payer-specific negotiated charges as a dollar amount. They will also be required to attest that all payer-specific negotiated charges that are not knowable in advance or cannot be expressed as a dollar amount, a MRF was provided and all necessary information available to the public be able to drive the dollar amount.
4. Hospitals will be required to encode their national provider identifiers in their MRFs.
5. CMS proposed to reduce the amount of civil monetary penalty for noncompliance with hospital price transparency requirements by 35% when a hospital agrees with CMS’ determination of their noncompliance and waives the right to a hearing.
