Authors
Today CMS released the Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center Final Rule, which included final changes in requirements to hospital machine-readable files (MRFs).
New MRF Requirements Include
Similar to the Proposed Rule, the Final Rule focused on a few core areas of change within the MRF:
- Percentile reporting (10th, 90th, and median amounts) to replace Estimated Allowed Amount reporting
- Changes to the MRF Affirmation Statement
- Additional reporting of the Type 2 NPI within the MRFs.
Most changes focus on nurturing accurate and useful MRFs
The changes are largely tied to a few themes, including a focus on getting patients a clear cost of care and holding hospitals accountable to maintaining accurate and useful MRFs. The Final Rule also went through key examples of how hospitals should correctly report the new percentile allowed amounts, specifics around the claims lookback period, and confirmation that GitHub and additional resources will be available as hospitals begin to work towards compliance.
Notably, enforcement of these new requirements has been delayed to 4/1/2026.
As always, Turquoise will read over the requirements in full and post more thoughts next week.
Until then!
Related resources
Learn, listen, and watch the latest on price transparency.
Transparency in Coverage Final Rule (2026): What Changes for Payer Machine-Readable Files
Payers will report by network instead of plan, move from monthly to quarterly, and attest to their data. We expect files to be slimmed down, more organized, and easier to find online.
Prescription Drugs Rates Get A Mandated Due Date with Dec 2027 Enforcement
What this means for manufacturers ability to provide patients a personalized OOP cost for drugs
Transparency in Coverage Update Trims Down Payer MRFs & Brings Back the Rx File
CMS's first major TiC overhaul since 2022 simplifies payer files and sets a December 2027 enforcement date for the prescription drug file. Here's what it means for patients and the industry