Machine-Readable File (MRF)
The comprehensive hospital pricing file, required by the Hospital Price Transparency Rule, containing gross charges, cash prices, and payer-specific negotiated rates for every item and service.
Machine-Readable File (MRF) is a term from U.S. hospital cost and quality reporting — the field that produces the CMS Hospital Compare program, the Medicare Inpatient Payment files, and the patient-facing tools built on top of them. The definition below covers what the term means in CMS files, what it does not mean, and how it interacts with the other measures CMS publishes. On the LakeQuality value rubric, Machine-Readable File (MRF) is one of the inputs (directly or indirectly) to the combined cost-and-quality grade. Understanding how the term is computed at CMS — what counts and what does not — is part of reading hospital pages defensibly.
Each hospital page on LakeQuality surfaces the specific Machine-Readable File (MRF) value for that facility (when CMS reports one), so the general definition here translates into a concrete data point on the per-hospital pages you actually use.
How It Works
The machine-readable file (MRF) is the technical heart of hospital price transparency. CMS requires every hospital to post a single digital file in CSV, JSON, or XML format containing all standard charges for all items, supplies, and services. Required data elements include: a description of each item/service, billing code (CPT, HCPCS, DRG, NDC, or revenue code) and code type, gross charge (chargemaster price), de-identified minimum negotiated charge across all payers, de-identified maximum negotiated charge, discounted cash price, and the payer-specific negotiated charge for every third-party payer and plan. A large academic medical center MRF routinely exceeds 500 MB and contains 2-5 million rows when expanded, because each CPT code may have 50-150 distinct negotiated rates across Aetna, UnitedHealthcare, Cigna, Anthem, Humana, and various Medicare Advantage, Medicaid managed care, and workers' compensation plans. CMS standardized the schema in July 2024, requiring hospitals to use a specific template that includes estimated allowed amounts for algorithmic or percentage-based contracts where a dollar figure cannot be precisely stated. The MRF must sit at a publicly accessible URL without login walls, CAPTCHA, or download fees, and file names must follow the format <ein>_<hospital-name>_standardcharges.<json/csv/xml>. CMS also requires a table of contents file and publication of the MRF URL in the hospital's root-level robots.txt. HospitalCostData aggregates MRFs from over 6,000 hospitals to power real-time price comparison, revealing cases where the cash-pay rate is lower than the rate a large insurer negotiated, and cases where the same insurer pays one hospital 4x what it pays another across the street.
Related Terms
- Hospital Price Transparency, A federal rule (effective January 1, 2021) requiring all U.S. hospitals to publicly display their prices, including chargemaster rates, negotiated rates with each insurer, and cash-pay discounts.
- Chargemaster (Charge Description Master), A hospital's master list of prices for every item and service, from a single aspirin to a heart transplant, typically containing tens of thousands of line items with prices that bear little relation to actual costs.
- Negotiated Rate, The payer-specific price a hospital has agreed to accept from a particular insurance plan for a service, usually 30-60% below the chargemaster gross charge.
- Cash-Pay Rate (Discounted Cash Price), The price a hospital charges self-pay or uninsured patients who pay directly, often substantially lower than both the chargemaster and some commercial negotiated rates.
- Shoppable Service, A common, non-urgent medical service that patients can plan and price-compare in advance, required by CMS to be listed with plain-language descriptions and prices on every hospital's website.
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About This Definition
This definition is part of the HospitalCostData Hospital Pricing Glossary, 47 terms explaining hospital costs, quality ratings, and healthcare billing. Written for patients, journalists, researchers, and healthcare professionals.