The Centers for Medicare & Medicare Services (CMS) released new guidance on how hospitals should calculate the estimated allowed amount values for their online machine-readable files as part of the Hospital Price Transparency requirements. Whenever possible, hospitals should use electronic remittance data to determine the average dollar amount received over the last 12-month period. If there is no historic data, hospitals should use the expected payment amount, encoded as a dollar figure. Hospitals will no longer be able to use a code of nine number nines to signify that there was not sufficient historic data for that item or service over the last year.
CMS also seeks public input by July 21, 2025 to identify challenges and improve compliance and enforcement processes related to the reporting of complete, accurate, and meaningful pricing data by hospitals.