Professional Rates

CMS requires hospitals to generate MRFs based in the hospital charges within the CDM. However, the final rule that went into effect on 1/1/21 also states that if a hospital directly employs any professional providers, the hospital must also include pricing and charge information for those providers in the MRF. This requirement remains in effect alongside the 2024 final rule.

At Turquoise, when our customers directly employ professionals, we retrieve their professional chargemasters, contract rates, and fee schedules. We include this information in the MRF and designate a billing class called "professional."

It's also important to note that in some states, hospitals are prohibited from directly employing physicians. In such cases, hospitals often work with affiliated medical groups. The prices for services provided by these affiliated groups are not included in MRFs.