CMS Final Rule Overhauls Payer Price Transparency Requirements
CMS, Labor and Treasury issued a final rule Oct. 5 revising 2020 price transparency regulations for payers, requiring them to remove "ghost rates" (rates for services a provider is unlikely to bill) from price files and have a senior executive attest to data accuracy, mirroring a requirement already imposed on hospitals. The rule consolidates in-network files to one per provider network, lowers the out-of-network reporting threshold from 20 to 11 claims, extends claims coverage from 90 days to six months, and moves updates to a quarterly cadence. It takes effect Dec. 5, with most data requirements phasing in through 2027; payers must post revised files by April 1, 2027, and offer personalized cost-sharing phone estimates for plan years starting Jan. 1, 2027. CMS says it will prioritize enforcement against payers, which have so far faced no public fines compared to 28 fined hospitals.