Hospital Price Transparency
Effective 4/2023
The Hospital Price Transparency regulation establishes enforceable guidelines by which hospitals must make public the standard charges they have established. The regulation defines several types of standard charges, including:
- Gross charges (as found in hospital chargemasters, which is the list of all individual items and services maintained by a hospital for which the hospital has established a charge, absent any discounts);
- Discounted cash prices (the charge that applies to an individual who pays cash or cash equivalent for a hospital item or service); and
- Charges negotiated between the hospital and third-party payers.
Hospitals are required to make these standard charges public in two ways:
- A single comprehensive machine-readable file with all standard charges established by the hospital for all the items and services it provides.
- A consumer-friendly display of standard charges for as many of the 70 CMS-specified shoppable services that are provided by the hospital, and as many additional hospital-selected shoppable services as is necessary for a combined total of at least 300 shoppable services. This requirement can be satisfied through the release of a shoppable services file or by offering a price estimator that generates a personalized out-of-pocket estimate that takes into account the individual’s insurance information.