Hospital Price Transparency (HPT)
Hospital Price Transparency (HPT) is a CMS system that supports the intake, review, investigation, and resolution of hospital price transparency complaints. The system enables enforcement teams to evaluate whether hospitals are meeting federally required transparency standards and to track each complaint through a structured, auditable lifecycle.
The Challenge
The primary challenge was designing a workflow that could handle incomplete, inconsistent, and time-sensitive complaints while maintaining reviewer confidence and regulatory correctness. Complaints often arrived with missing context, unclear evidence, or varying levels of detail, requiring the system to support judgment and investigation rather than simple validation.
Intake and Case Creation
Complaints enter the system through a CMS website form. Each complaint references a hospital, selected from a preloaded list or manually added when the hospital does not already exist in the system.
Not all complaints are immediately actionable. Eligibility checks determine whether a complaint can be converted into a case. Once eligibility criteria are met, the complaint transitions into a case and enters the enforcement workflow.
“Complaint intake and eligibility review, where incomplete submissions are evaluated before becoming cases.”
“Case lifecycle states showing review progress, required actions, and current status.”
Lifecycle Design
Cases move through a series of defined stages that reflect review, investigation, and resolution activities. Each stage communicates status, required actions, and next steps to reviewers, helping teams manage workload while maintaining a clear audit trail.
The lifecycle design prioritizes clarity over automation, ensuring reviewers always understand where a case stands and what decisions are required next.
Automation and Review
As part of the investigation process, the system integrates with ACE to scan hospital websites for required price transparency information. Automated results support reviewer analysis but do not replace human judgment.
The design balances automation with oversight, allowing reviewers to validate findings, interpret results, and document decisions within the same workflow.
“Automated website scan results supporting, but not replacing, reviewer judgment.”
“Case history view maintaining a traceable record of actions and decisions.”
Outcome
The resulting system provides a consistent and traceable process for handling hospital price transparency complaints. Reviewers gain clearer visibility into case status and history, while enforcement decisions are supported by structured workflows that emphasize accountability and auditability.