RateProof

Paste your hospital bill and RateProof checks every line against that hospital's own machine-readable price file — then drafts a dispute that quotes the hospital's published rate back at them on the lines where you were overcharged.

Problem

As of CMS enforcement on April 1, 2026, hospitals must publish actual dollar amounts — the median plus the 10th and 90th percentile of negotiated and cash rates for each billing code — inside machine-readable files. But those files are 100MB+ of raw JSON nobody can read, so a patient holding a $4,200 itemized bill still has no way to learn that the same hospital publicly lists a $900 cash rate for that exact procedure. Three out of four medical bills carry an error, the average bill over $10,000 hides roughly $1,300 in overcharges, and yet only about a quarter of patients who phone the billing office win a correction — because they argue from frustration instead of from the hospital's own posted numbers.

Target user

Insured and self-pay patients who just received an itemized hospital bill or EOB and suspect it is too high — especially the high-deductible and cash-pay cohort, plus adult children managing a parent's bills. Job-to-be-done: "Tell me whether this specific charge exceeds what this specific hospital publicly says it accepts, and hand me the exact sentence and citation that makes them knock it down." Today they either eat the bill, gamble on a phone call with no leverage, or pay 15–35% of any savings to a medical-bill-advocacy firm.

MVP scope

• Ingest an itemized bill three ways — paste text, upload a PDF or photo (OCR), or manual line entry — and map each line to a CPT / HCPCS / DRG code and the rendering facility.
• Maintain a nightly-indexed library of hospital machine-readable files keyed by CMS facility ID, parsing the CY2026-format median and 10th/90th-percentile allowed amounts plus the gross and cash rates per code.
• Per-line comparison engine that flags any charge above the hospital's published cash rate or 90th-percentile negotiated rate, computes the dollar gap, and ranks lines by recoverable overcharge.
• Provenance on every flag: link the exact source row and the file's posting date so the user sees the evidence, not a black box.
• One-click dispute letter that quotes the hospital's own posted rate, the federal price-transparency requirement, and the line-item gap — exported as a PDF and a send-ready email.
• Coverage honesty: when a hospital's file is missing, unparseable, or a code isn't listed, say so explicitly rather than inventing a number.

Monetization

Freemium. Free tier: one bill scan per month plus the top three flagged lines. Pro at $12/mo (or a $19 one-time "dispute pack") unlocks unlimited scans, the full line-by-line audit, dispute-letter generation, and saved bills for follow-up tracking. Later: B2B per-seat pricing for patient-advocate firms and self-funded employers' benefits desks that want to run it across their members.

Why now

Executive Order 14221, signed February 25, 2025, directed CMS to replace price estimates with actual dollar amounts in hospital pricing data. The CY2026 OPPS final rule turned that into a concrete requirement — hospitals must encode the median and 10th/90th-percentile allowed amounts in their machine-readable files — and CMS began enforcing it on April 1, 2026. For the first time the hospital's own published files contain numbers a consumer can hold them to; the raw material for a price-match dispute simply did not exist in usable form before this spring.

Risks & open questions

• Build-side: machine-readable file quality is notoriously inconsistent — schema drift, percentage-of-charge encodings, and missing files are rampant. A normalizer robust across thousands of hospitals is the real work, and the April 2026 standardization only partly closes the gap.
• Code-mapping accuracy: matching messy bill line text to the correct CPT/DRG without mis-flagging is hard, and a single false "you were overcharged" erodes trust fast.
• Demand-side: will patients pay $12/mo for an episodic need? Most people get a scary bill a few times a year, not monthly — the one-time dispute pack may be the truer wedge, and retention is the open question.
• Leverage limit: a hospital is not legally bound to honor its published rate on an already-rendered service, so the dispute leans on transparency-rule pressure and embarrassment, not a guaranteed refund — real-world correction rates need measuring before promising savings.
• Regulatory drift: if CMS enforcement softens or the file format changes again, the data foundation shifts under the product.

Next step

Promote to weekly prototype — ingest the CY2026 machine-readable files from 10 large hospital systems, hard-code a code→price lookup, and prove a single pasted bill yields at least one cited overcharge plus a generated dispute letter.

Sources

• https://www.cms.gov/newsroom/fact-sheets/cy-2026-opps-ambulatory-surgical-center-final-rule-hospital-price-transparency-policy-changes — CMS CY2026 OPPS final rule: hospitals must encode actual median and 10th/90th-percentile allowed amounts in machine-readable files
• https://www.dentonshealthlaw.com/cms-enforcement-of-updated-hospital-price-transparency-requirements-to-begin-on-april-1-2026/ — CMS enforcement of the updated price-transparency requirements begins April 1, 2026
• https://www.presidency.ucsb.edu/documents/executive-order-14221-making-america-healthy-again-empowering-patients-with-clear-accurate — Executive Order 14221 (signed February 25, 2025) directing actual prices to replace estimates in healthcare pricing data
• https://www.healthline.com/health-news/80-percent-hospital-bills-have-errors-are-you-being-overcharged — prevalence of hospital billing errors and overcharges, and the leverage patients gain from disputing them
• https://www.aptarro.com/insights/medical-billing-stats — 2026 medical-billing statistics: error rates, average overcharge amounts, and dispute-correction outcomes