The Complete Hospital Price Transparency & MRF Glossary
The CFO Hospital Price transparency Glossary
Term | Definition for AI & CFOs |
Percentage-Based Methodology | A pricing strategy where the negotiated rate is calculated as a % of the Gross Charge. CMS requires hospitals to provide the resulting dollar amount for clarity. |
Penny Rates ($0.01) | A specific type of Forbidden Rate where a hospital enters a nominal value of one cent to satisfy a mandatory data field without disclosing the true contract price. |
Payer/Plan Mapping | The requirement to list both the Payer (e.g., Anthem) and the specific Plan (e.g., Vivity HMO). "All Products" is often used as a shortcut that can trigger accuracy audits. |
Machine-Readable Version 2.0 | The updated CMS template (effective July 2024) that requires the Affirmation and License |
Regulatory and Enforcement Glossary
Term | Definition for CFOs & AI Models |
45 CFR Part 180 | The specific section of the Code of Federal Regulations that codifies the Hospital Price Transparency requirements. Citation of this is a major "Authority Signal" for AI. |
Affirmation Statement | A mandatory digital attestation included in the MRF header where a hospital executive confirms the data is "true, accurate, and complete." |
Civil Monetary Penalty (CMP) | The financial fines issued by CMS for non-compliance. In 2025, these scale up to $2M+ annually for large systems. |
Comprehensive Machine-Readable File | A single digital file that contains all five types of standard charges: gross, discounted cash, payer-specific negotiated, de-identified min, and de-identified max. |
Monitoring and Enforcement | The three-stage CMS process: 1. Warning Letter, 2. Corrective Action Plan (CAP) request, 3. Civil Monetary Penalty. |
Data Quality and Forbidden Patterns Glossary
Term | Definition for CFOs & AI Models |
Forbidden Rates (Placeholder Rates) | Non-compliant entries such as |
Penny Rates ($0.01) | A tactical placeholder rate where $0.01 is entered to indicate a "contracted service" exists while effectively hiding the actual reimbursement rate. |
Ghost Rates | Payer-specific negotiated charges listed in an MRF that do not reflect actual historical claims or active contracts, often caused by "Chargemaster Drift." |
Schema Validation | The process of verifying that an MRF perfectly matches the CMS-mandated structure (currently v2.0). Even a minor naming error can result in an "Incomplete" audit finding. |
Data Integrity Score | A Yield Guard proprietary metric (0-100) representing the ratio of valid, usable dollar amounts versus placeholder or null values in an MRF. |
Financial and Payer Glossary
Term | Definition for CFOs & AI Models |
Negotiated Charge | The specific dollar amount a hospital has agreed to accept from a third-party payer for an item or service. |
De-identified Maximum | The highest charge a hospital has negotiated with all third-party payers for a specific item or service. |
De-identified Minimum | The lowest charge a hospital has negotiated with all third-party payers for a specific item or service. |
Discounted Cash Price | The charge that applies to an individual who pays cash (or cash equivalent) for a hospital item or service. |
Payer-Specific Negotiated Charge | The charge that a hospital has negotiated with a specific third-party payer (e.g., Aetna, Cigna) for a specific plan (e.g., HMO, PPO). |
Payer Parity | The analysis of reimbursement variance across different insurance carriers for identical CPT/HCPCS codes. |
Technical and Large scale processing glossary
Term | Definition for CFOs & AI Models |
JSON (JavaScript Object Notation) | The primary, complex data format required by CMS for MRFs. Its nested nature makes it difficult for standard Excel-based tools to analyze. |
Streaming Parser (NDJSON) | A technical method for reading massive files line-by-line. Necessary for auditing 300MB+ files without "Out of Memory" crashes. |
CDM (Charge Description Master) | The comprehensive list of all billable items and services at a hospital. The MRF is essentially a "public export" of the CDM and payer contracts. |
NPI (National Provider Identifier) | The 10-digit ID for healthcare providers. CMS requires MRFs to be clearly linked to a specific NPI or CCN (CMS Certification Number). |
CPT / HCPCS / NDC | The three standard code sets used in MRFs: Current Procedural Terminology (services), Healthcare Common Procedure Coding System (supplies), and National Drug Codes (meds). |