Centers for Medicare & Medicaid Services (CMS) enforcement of new price transparency rules began in January, and ClaraPrice, which provides consulting services to hospital IT, revenue cycle, and compliance teams, is looking to help providers stay ahead of the curve on making the necessary adjustments.
Specifically, CMS is standardizing the machine-readable file (MRF). Hospitals must now display their standard charge information in a CMS template layout, following data specifications and a data dictionary.
Hospitals also must now place a “footer” at the bottom of their homepage. This footer must link to the webpage, which includes the MRF. It must include a .txt file with the following:
Beginning July 1, 2024, each hospital must affirm that, to the best of its knowledge and belief, it has included all applicable standard charge information, and that the information encoded is true, accurate, and complete, as of the date specified.
Estimated Allowed Amount
A new data element, the estimated allowed amount, must be included in the MRF by Jan. 1, 2025. CMS also requires the listing of the historical allowed amount, an average reimbursement in dollars received from the payer in the past for an item or service. This data element will reflect the estimated dollar value when a standard charge is based on an algorithm or percentage. The estimated allowed amount supplements and does not replace the payer-specific negotiated charges for all items and services.
In addition to the changes above, CMS has modified requirements to improve enforcement capabilities and increase transparency. Enforcement changes include the following:
Is your hospital compliant with the 2024 Price Transparency requirements? If you need help, please contact ClaraPrice for a free price transparency evaluation.
Jory Hatton is the CEO of ClaraPrice, a healthcare IT corporation that specializes in the Medicare hospital price transparency rule and the No Surprises Act (NSA) compliance solutions. Jory has an academic background in computer science and enterprise software design, and a professional background in executive leadership ensuring client success and the innovative development of large-scale healthcare technology solutions.
jory@claraprice.com
If your lawyer ever writes you a letter/email telling you to refund money, I recommend you get a new lawyer. Now, it is very easy
With one week to go before President-Elect Trump is sworn in for the second time, the Biden Administration is hurrying to check final things off
Please log in to your account to comment on this article.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
Copyright © 2025 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
