Hospital Price Transparency

How It Works

The Hospital Price Transparency rule (CMS-1717-F2) requires hospitals to publish two things: (1) a comprehensive machine-readable file containing all standard charges (gross charges, negotiated rates per payer, de-identified minimum/maximum negotiated charges, and discounted cash prices) for all items and services; and (2) a consumer-friendly display of shoppable services (at least 300 services, including 70 CMS-specified services). Compliance has been mixed — studies show only 20-30% of hospitals are fully compliant. CMS has gradually increased penalties for noncompliance, but enforcement remains a challenge. The data that compliant hospitals publish reveals enormous price variation: the same procedure can cost 2-10x more at one hospital than another in the same city.

Related Terms

• Chargemaster (Charge Description Master) — A hospital's master list of prices for every item and service — from aspirin to surgery — typically containing tens of thousands of line items with prices that bear little relation to actual costs.
• Surprise Medical Bill (Balance Billing) — An unexpected bill from an out-of-network provider — often occurring during emergencies or when an in-network hospital uses out-of-network specialists without the patient's knowledge.