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.
On November 21, 2025, CMS released the CY26 OPPS Final Rule and—importantly—most of the major proposals relating to hospital price transparency (our summary and comment here) have been adopted as final requirements. Hospitals should be aware that the compliance and reporting obligations discussed throughout the rule-making process are now moving forward, with only minor modifications. This summary highlights the key changes, and includes our firm’s perspective on what’s most important, what m...
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!
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...