In alignment with one of President Trump’s Executive Orders, the Department of Health and Human Services and the U.S. Treasury have released new guidance and a joint request for information. In the updated guidance, CMS requires that hospitals post their standard charges as a dollar amount in their machine-readable files, so that patients can better understand how much their care might cost. CMS clarifies that, per the CY 2024 Outpatient Prospective Payment System final rule:  

• If it can be calculated, hospitals must encode standard charge dollar amounts in the Machine-Readable File (MRF). This should include the amount negotiated for the item/service, the base negotiated rate for a service backage, and/or a dollar amount “if the standard charge is based on a percentage of a known fee schedule.” 

• Hospital should stop using “nine nines” (999999999) in the estimated allowed amount data element. Instead, CMS requests that hospitals encode an actual dollar amount in this space. 

CMS stated that it expects most hospitals to show their payer-specific negotiated rates as a dollar amount but recognizes that there may be situations where the hospital’s finance team may instead be provided with a percentage. The GitHub for developers has now been updated with common coding scenarios and examples for reference.