CMS Final Rule:

Hospital Pricing Transparency

CMS’s recent final rule aims to strengthen hospital price transparency requirements beginning in 2026. Hospitals must publicly disclose actual (rather than estimated) allowed amounts along with counts and National Provider Identifiers (NPIs) in machine readable files (MRFs), backed by a formal accuracy attestation. While this could certainly increase price transparency, the required MRFs remain highly technical and difficult for the average consumer to interpret. As a result, employers and third-party tools will play a critical role in translating these data into usable insights for plan members. That being said, more accurate, transparent pricing data may give employer-sponsored group health plans stronger leverage in evaluating hospital contracting and benchmarking provider prices. Employers might also use the information to enhance benefit design strategies such as tiered networks, reference pricing, and steering toward lower-cost care settings. The fact sheet for the final rule can be found here: CY 2026 OPPS and Ambulatory Surgical Center Final Rule – Hospital Price Transparency Policy Changes | CMS

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