The CMS rule requires three distinct price types in your MRF: gross charges (the sticker price), discounted cash prices (what cash-paying patients pay), and payer-specific negotiated rates (what each insurer's plan pays). They are NOT interchangeable.
This is the full undiscounted price listed in your chargemaster — the starting point before any discount or negotiation. It must be published for every item and service.
The price a cash-paying patient would actually pay — often 20-40% below the gross charge. CMS requires this on every item. Hospitals that omit it risk a violation on every missing item.
The amount your hospital and a specific health plan agreed to pay for a specific service. This must be broken out payer-by-payer, plan-by-plan. A blended average does not comply.
Hospitals often publish only gross charges — treating the chargemaster as the whole requirement. This misses two of the three required price types and leaves the file non-compliant.
A validator compares your file against the full CMS data specification, flagging every missing price type, every absent payer, and every mismatched code.
Find out if your file has all three price types — free risk check.
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