Hospital advocates urge CMS to hold off on new price transparency requirements
Advocates said hospitals' compliance efforts were the reason why CMS has only issued 27 civil monetary penalties, despite thousands of enforcement actions.
Federal regulators should hold off on further price transparency requirements and more enforcement, hospital advocates recently told CMS.
The hospital advocacy groups’ comments were in response to a May request for information (RFI) from CMS on ways to implement President Donal Trump’s executive order to ensure compliance with the transparent reporting of complete, accurate and meaningful data. CMS sought input on “whether and how CMS can improve hospital price transparency (HPT) compliance and enforcement processes to ensure that the pricing information in the machine-readable file (MRF) is accurate and complete.”
The Federation of American Hospitals (FAH) urged CMS not to undertake further regulatory changes and said “both hospitals and users of hospital price transparency data would benefit from a period of relative regulatory stability during which the already widespread hospital compliance achieved by CMS may be deepened.”
The American Hospital Association (AHA) detailed transparency enforcement actions taken, so far, and urged no new enforcement initiatives.
CMS price transparency enforcement from Jan. 7, 2021 to March 31, 2025, according to AHA, included:
- More than 6,000 audits and enforcement actions in more than 3,000 unique cases
- Nearly 1,000 were found to comply at the time of the audit
- Nearly 2,000 came into compliance following CMS action
- About 300 cases opened in 2025
“It is because of hospitals’ efforts that CMS has only issued 27 civil monetary penalties, rather than a lack of CMS’ active auditing or enforcement,” wrote Ashley Thompson, senior vice president of public policy analysis and development for AHA.
But industry advisers warn that CMS is unlikely to take its foot off the gas.
“And I think what’s happening or is going to happen, but hasn’t happened yet, there’s an increase in activity, but the penalties have not really hit hard yet,” David Cardelle, chief strategy officer at AMS, said on a recent podcast. “And I think they’re planning on that.”
New approaches
If CMS is determined to undertake more actions on transparency, hospital advocates had some suggestions.
Payer focus. AHA suggested CMS focus on ensuring that pre-service estimates are as accurate as possible by changing benefit design requirements to reduce or eliminate cost-sharing calculated after the course of care is complete. Instead, it could require flat co-payments to ensure the patient portion remains the same even if the total price varies from unanticipated services.
“Another alternative could be to remove providers from the cost-sharing collection process altogether and instead require insurers to be responsible for cost-sharing estimates and collections,” Thompson wrote.
Streamlining. HFMA urged CMS to streamline and align policies to ensure that compliance efforts enhance — rather than hinder — accessibility, accuracy and the delivery of care.
HFMA noted that the growing patchwork of price transparency mandates at both the state and federal levels is generating confusion, administrative burden and operational friction — rather than delivering clarity.
“A fragmented approach risks misalignment among key stakeholders across the healthcare ecosystem,” Richard Gundling, senior vice president of professional practice for HFMA, wrote in a July 21, 2025, letter to CMS.
Enforcement concerns
Both recently issued and potential enforcement approaches raised concerns from hospital advocates.
FAH raised concerns about May guidance that reversed previous instructions to use nine 9s for the estimated allowed amount where the payer uses a percentage or algorithm to determine payment for an item or service and the hospital lacks the historical data necessary to derive an estimated allowed amount for that item or service.
Instead, the guidance included three approaches to replacing the nine 9s in the MRF files.
“The FAH believes that where hospital data is insufficient to reliably calculate an estimated allowed amount, users of the machine-readable file should rely on the accurate data regarding the percentage or algorithm that is the basis of payment and that the encoding of an estimated allowed amount based on a low volume of claims or hospital expectations diminishes the accuracy of the machine-readable file,” FAH wrote.
Some industry watchers have raised the possibility that CMS may move to review the accuracy of data in price transparency reports and penalize hospitals based on those findings.
The RFI asked about how to define “accuracy of data” and “completeness of data” in hospital reporting.
AHA noted that hospitals do their best to create negotiated rates for the MRFs that are as close as possible to how the final services may ultimately be paid. But they must make detailed assumptions about “how to apply complex contracting terms and assess historic data to create a reasonable value for an expected allowed amount.”
“Ultimately, there is no tool or dataset that CMS could use to assess or verify these calculations, and we continue to strongly support attestations of accuracy for purposes of CMS assessments,” Thompson of AHA wrote.
