Proposed rule would ride price transparency of cumbersome files, “ghost rates”

Price transparency is receiving renewed attention years after the Transparency in Coverage (TiC) final rule first went into effect – and not necessarily for the right reasons. While hospitals and insurers are being pushed to release negotiated rates for services, the information they reveal isn’t always valid or valuable. 

The spotlight turned back on in February 2025 with President Donald Trump’s executive order to strengthen price transparency requirements, which patients and advocacy groups argued wasn’t being enforced. At the end of last year, the Centers for Medicare & Medicaid Services (CMS), Department of Labor, and Department of the Treasury issued a proposed rule piggybacking on the executive order aimed at making pricing information standardized and more accessible. 

The original TiC rule went into effect in 2022 and required disclosure of the negotiated price for elective, “shoppable” in-network services between payers and providers in machine-readable format. In a statement accompanying the proposed rule, CMS noted the first rule hadn’t “fully achieved” its goals due to four main barriers: Terabyte-sized files, a lack of context alongside raw data, an inability to compare data from disparate disclosing entities, and the inclusion of “negotiated rates for items or services [providers] would be unlikely to furnish.” 

A shocking number of “ghost rates”

Simple Healthcare CEO David B Muhlestein uses the term “ghost rates” to describe published rates for services no provider would ever bill for, such as podiatrists or psychiatrists performing open-heart surgery.  

The concept sounds ridiculous, but it’s shockingly widespread. In a November 2025 paper in Health Affairs Scholar, Muhlestein detailed his analysis of TiC files from 61 insurers (three national insurers and 58 Blues plans) and found nearly 92% of TiC files contained ghost rates. The prevalence is admittedly lower for common billing codes such as routine office visits, but more than 70% of the most common billing rates are still ghost rates. 

Muhlestein suggested a straightforward solution for revealing ghost rates: Requiring insurers to include volume information that indicates how many times a provider organization was paid for the billing code captured in the negotiated rate. That would let anyone looking at the data weed out any services that were not or could not be provided. Otherwise, Muhlestein said, “most analysts will be reliant on data vendors to identify ghost rates,” and “TiC files will [unlikely] readily be accessible to patients and unsophisticated employers.” 

A matter of format

Inaccessibility has long plagued price transparency: Data files are traditionally incomplete and non-standardized, and aforementioned data vendors have had to aggregate and standardize the information – for a price. 

To that end, the CMS statement indicated a desire to restrict machine-readable files to a single format. Without saying so outright, the agency appeared to favor JSON, as more than 90% of files currently use that format. 

Two researchers at the Brookings Institute have a different idea: Apache Parquet. JSON “is cumbersome for data users because it stores data inefficiently and is computationally costly to parse.” Meanwhile, researchers said, Apache Parquet is designed to “allow for much lower file sizes and processing times” as well as “broad programming language support.” 

The comment period on the TiC proposed rule is now closed, so it’s anyone’s guess when the final rule will be issued or go into effect. In the meantime, the struggle to make sense of pricing data continues. 

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.