For decades, hospital pricing in the US was confusing and inconsistent – sometimes blindsiding patients when the bill arrived. That finally began to change when the Centers for Medicare & Medicaid Services (CMS) hospital price transparency law was introduced in 2021.
It mandated that every hospital must publish a machine-readable file (MRF) containing up-to-date prices of all items and services, as well as a consumer-friendly display of at least 300 shoppable services.
From Placeholder Codes to Real Pricing Data
However, early compliance was spotty. Many hospitals included placeholder codes (like “999999999”) where they lacked historical pricing data. According to a recent analysis, 63% of major hospitals encoded at least one “999999999” in their MRFs – while 38% encoded nine 9s for over 90% of their data fields. In effect, hospitals fulfilled the letter of the rule, but not the spirit.
The CMS’s latest guidance aims to fix that. Under new enforcement policies, every provider – large systems and standalone hospitals alike – must now not only publish their prices but also ensure they are accurate, up-to-date and machine-readable.
Therefore, hospitals must replace these placeholders with real estimated charges, even if they’re based on limited historical data or reasonable expected payments.
In other words, no more excuses for non-compliance. If a procedure was rarely performed or never billed, providers must now derive pricing using methods like electronic remittance advice (ERA) data from the last 12 months, expected reimbursement rates or negotiated payer fee schedules.
Why This Matters More Than Ever
For hospitals, this new level of transparency will now be a key determinant of market strategy and patient trust.
In addition to the obvious consequences on non-compliance (increased CMS scrutiny and reputational risk), organizations that don’t track how their prices compare to competitors may be:
- Overpricing and losing volume to more affordable alternatives
- Underpricing and leaving money on the table
- Out of sync with reimbursement trends that affect their bottom line
With patients, payers and policymakers demanding visibility, pricing has become an essential lever for network optimization and contracting.
The Catch: Finding and Comparing Pricing Data is a Nightmare
Yes, hospitals are now required to publish pricing data, but that doesn’t mean it’s easy to access or compare.
Even today, machine-readable files are scattered across thousands of individual hospital websites.
Many are poorly structured or inconsistently formatted. Some are updated regularly, others rarely. Sifting through this patchwork of data to understand what competitors charge across services, specialties or geographies is time-consuming at best, and impossible at worst.
Yet this is exactly the data providers now need to:
- Benchmark rates against local and regional peers
- Set or adjust prices for underused or unpriced services
- Align pricing strategies with changing payer dynamics
In short, it’s not enough to publish your own prices. You also need visibility into everyone else’s.
The Good News: You Don’t Have to Do It Alone
Trusted Price Intelligence: A Smarter Way to Benchmark
Collecting and analyzing hospital pricing data used to be an extremely fragmented manual task. But thanks to PurpleLab, it no longer has to be.
We’ve partnered with Payerset, the industry leader in enterprise price transparency, to offer hospitals a seamless way to access and compare pricing data across providers, regions and services.
By combining Payerset’s comprehensive, continuously updated pricing dataset with PurpleLab’s comprehensive claims data, providers can now:
- Instantly benchmark their rates against competitors
- Access real-time pricing trends across specialties and geographies
- Make data-backed decisions about pricing, investment and care delivery
The result? Price transparency delivered in a way that’s finally actionable with no coding necessary.
For hospitals ready to turn transparency into insight – and insight into action – the time to start is now. Contact us today to discover how PurpleLab can help.