In this blog, we break down the current state of hospital machine-readable file (MRF) data, recent regulatory updates, ongoing challenges, and how Payerset simplifies these complexities to provide the most user-friendly and actionable insights.
The State of Hospital MRF Data
Unlike the Transparency in Coverage (TiC) rule, which applies to insurance carriers, hospital price transparency regulations are a separate initiative with different requirements, schemas, and implementation timelines. When hospital price transparency requirements were first introduced, the lack of standardization made meaningful analysis nearly impossible. Hospitals published data in different structures, with no consistency in file formats, terminology, or coding methodologies. Some of the biggest challenges included:
Inconsistent File Formats – No unified schema for reporting, making data difficult to compare.
Limited Field Utility – Missing or vague pricing fields made apples-to-apples comparisons difficult.
Lack of Cross-Referencing – Theoretically, hospital-posted prices should match payer-posted prices, but discrepancies were common.
Disorganized File Hosting – No centralized or predictable locations for file access.
Was this lack of consistency intentional obfuscation or just poor implementation? The reality is likely a mix of both, compounded by resource constraints within hospital IT teams.
Key Updates: New 2024-2025 Hospital Price Transparency Regulations
July 2024: Standard Charges Format Implementation
To improve data consistency, the July 1, 2024, regulations introduced a standardized format, requiring hospitals to publish:
JSON Schema – A structured, machine-readable format for improved parsing.
Wide-Form CSV Format – A more accessible but still structured alternative.
January 2025: Further Enhancements
Starting in January 2025, additional measures were implemented to improve usability and compliance:
Increased Accessibility – Hospitals must prominently display links to their MRFs in website footers.
Affirmation of Data Accuracy – Hospitals must attest that their posted data is complete and correct.
New Data Elements:
Estimated Allowed Amounts – Projected pricing for services.
Drug Unit Measurement Standardization – Making National Drug Code (NDC) comparisons easier.
The Centers for Medicare & Medicaid Services (CMS) provides a detailed breakdown of the Hospital Price Transparency Rule, including the latest regulatory updates effective July 1, 2024. Similarly, the American Hospital Association (AHA) discusses how hospitals are implementing these new requirements. These updates were significant steps forward, but they didn’t entirely solve the challenges of normalizing hospital price data for analysis.
Ongoing Challenges in Hospital MRF Data Standardization
Despite improved formatting and regulatory oversight, several challenges persist:
1. Payer Name and Plan Name Inconsistencies
Different hospitals refer to the same payer in multiple ways like:
UnitedHealthcare might appear as “UHC,” “United,” or “UnitedHealthcare.”
Cigna could also be listed as “LifeSource” for transplant networks.
Blue Cross Blue Shield (BCBS) variations make it difficult to determine the exact plan.
2. Billing Code Variability
Some hospitals use a single billing code for a procedure (e.g., one CPT code for a colonoscopy).
Others list multiple billing codes, each with slightly different pricing structures.
There’s no uniform approach, making it hard to determine whether differences stem from contract negotiation, billing methodology, or simple misclassification.
3. Slow Adoption of New Compliance Measures
Hospitals are only required to update MRFs once per year, meaning outdated formats linger.
Many hospitals are still catching up on compliance, delaying the effectiveness of new regulations.
Despite regulatory improvements, compliance remains a major issue. According to a report from the Office of Inspector General (OIG), a significant percentage of hospitals have yet to fully comply with the transparency rule. Additionally, a Patient Rights Advocate report found that compliance among hospitals has actually declined, highlighting ongoing inconsistencies in hospital-reported pricing.
How Payerset Solves These Challenges
We take a human-first approach to organizing, simplifying, and making hospital price transparency data more actionable and accessible.
1. Payer Name & Plan Name Normalization
We standardize payer names and plan names so that they are consistent across all hospital files. This allows for easy comparison across hospitals and alignment with payer-posted data.2. Billing Code Categorization
We map hospital billing codes to categorized, easy-to-understand procedure groups. This helps remove noise from the data and ensures proper comparability across providers.3. Compliance Tracking & Continuous Monitoring
We track hospitals’ compliance with regulations and update our datasets accordingly. As hospitals gradually align with the new standards, we incorporate their latest data for accuracy.4. Seamless Integration with Payer Data
By linking hospital-posted data with Transparency in Coverage payer data, we provide a holistic view of healthcare pricing.This allows better benchmarking and removal of outliers to enhance pricing insights.Hospital price transparency is improving, but significant challenges remain. Payerset makes it easy to work with hospital and payer data, eliminating inconsistencies and enabling smarter analysis.
🔎 See Payerset in action! Contact us today for a demo and experience the easiest way to analyze hospital price transparency data.