We analyze hospital prices at the procedure code level and present an analysis of suggested rate changes designed to enhance the defensibility of proposed pricing with sensitivity to financial impact.
Web-based software that creates custom analyses of financial/operating strengths, weaknesses, and opportunities. Utilizes client-submitted claims data as well as national public-use data.
Patient Rights Advocate (PRA) has released its Interim Semi-Annual Hospital Price Transparency Report dated September 2025 which claims hospitals are failing to comply with federal price transparency rules—especially when it comes to posting negotiated rates in dollars and cents. However, the report’s conclusions are based on a fundamental misunderstanding or misrepresentation of both the CMS requirements and the realities of hospital-payer contracts.
Let’s break down where the report goes of...
CMS has released new price transparency guidelines for hospitals, including guidance specific to the production of the machine-readable file (MRF). We offered a free webinar to go over the proposed changes in detail. You can watch it now!
You can download the slides here.
We help hospitals prepare their machine readable files. If you’d like to discuss how we can help your facilities, you can contact us here!
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On July 15, 2025, the Centers for Medicare & Medicaid Services (CMS) released the CY26 Outpatient Prospective Payment System (OPPS) Proposed Rule, which includes significant updates to the Hospital Price Transparency (HPT) requirements. These proposals aim to improve the accuracy, comparability, and usability of pricing data for consumers, payers, and policymakers.
Below is a high-level overview of the key areas that may impact your hospital’s compliance and reporting obligations, as well...
RESPONSES PROVIDED BY CLEVERLEY + ASSOCIATES July 21, 2025
Recently, CMS released a Request for Information regarding the accuracy and completeness of hospital machine-readable files (MRFs). According to the request, “To meet the President’s Executive Order to ensure compliance with the transparent reporting of complete, accurate, and meaningful data, CMS seeks public input on whether and how CMS can improve hospital price transparency (HPT) compliance and enforcement processes to ensure that...