Frequently asked questions about Hospital Price Transparency
Under the CMS Hospital Price Transparency rules, hospitals must publish specific standard charges so patients can compare costs. The three key pricing categories are:
What it is: The base rate the hospital has directly negotiated with a specific third-party insurance company or plan.
Details: This represents a specific dollar amount (or calculated algorithm/percentage) and does not include non-negotiated rates like traditional Medicare or Medicaid. Hospitals are also required to publicly list the de-identified minimum and maximum negotiated charges across all payers for every service.
What it is: The flat rate (or package price) the hospital charges individuals who pay cash, or its equivalent, out-of-pocket.
Details: This rate is generally intended for uninsured patients or those who choose not to use their insurance for a specific service.
What it is: The hospital’s official, undiscounted "list price" for an individual item or service as reflected on their chargemaster.
Details: This rate does not include any discounts, and is rarely the actual amount paid by insurance companies or patients.
Hospitals must publish these charges in two formats: a consumer-friendly list of at least 300 “shoppable services” and a massive, comprehensive machine-readable file (MRF).
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