Skip to content

Commit

Permalink
Adding flexibility to include 'both' for billing classes where negoti…
Browse files Browse the repository at this point in the history
…ated rates are the same across professional and institutional. Discussion: #366
  • Loading branch information
shaselton-usds committed Aug 21, 2023
1 parent 327384c commit c4e7430
Show file tree
Hide file tree
Showing 3 changed files with 5 additions and 3 deletions.
4 changes: 2 additions & 2 deletions schemas/in-network-rates/README.md
Original file line number Diff line number Diff line change
Expand Up @@ -101,7 +101,7 @@ The negotiated price object contains negotiated pricing information that the typ
| **negotiated_rate** | Negotiated Rate | Number | The dollar or percentage amount based on the `negotiation_type` | Yes |
| **expiration_date** | Expiration Date | String | The date in which the agreement for the `negotiated_price` based on the `negotiated_type` ends. Date must be in an ISO 8601 format (i.e. YYYY-MM-DD). See additional notes. | Yes |
| **service_code** | Place of Service Code | An array of two-digit strings | The [CMS-maintained two-digit code](https://www.cms.gov/Medicare/Coding/place-of-service-codes/Place_of_Service_Code_Set) that is placed on a professional claim to indicate the setting in which a service was provided. When attribute of `billing_class` has the value of "professional", `service_code` is required. | No |
| **billing_class** | Billing Class | String | Allowed values: "professional", "institutional" | Yes |
| **billing_class** | Billing Class | String | Allowed values: "professional", "institutional", "both" | Yes |
| **billing_code_modifier** | Billing Code Modifier | Array | An array of strings. There are certain billing code types that allow for modifiers (e.g. The CPT coding type allows for modifiers). If a negotiated rate for a billing code type is dependent on a modifier for the reported item or service, then an additional negotiated price object should be included to represent the difference. | No |
| **additional_information** | Additional Information | String | The additional information text field can be used to provide context for negotiated arrangements that do not fit the existing schema format. Please open a Github discussion to ask a question about your situation if you plan to use this attribute. | No |

Expand All @@ -117,7 +117,7 @@ For `expiration_date`, there may be a situation when a contract arrangement is "

In situation where there is not expiration date ([see discussion here](https://github.com/CMSgov/price-transparency-guide/discussions/42)), the value `9999-12-31` would be entered.

For `service_code`, if a negotiated rate for either "professional" or "institutional" `billing_class` is the same for all `service_code`s, the custom value of `CSTM-00` can be used to avoid listing all possible service codes.
For `service_code`, if a negotiated rate for either "professional", "institutional", or "both" `billing_class` is the same for all `service_code`s, the custom value of `CSTM-00` can be used to avoid listing all possible service codes.

```json
{
Expand Down
3 changes: 2 additions & 1 deletion schemas/in-network-rates/in-network-rates.json
Original file line number Diff line number Diff line change
Expand Up @@ -389,7 +389,8 @@
"billing_class": {
"enum": [
"professional",
"institutional"
"institutional",
"both"
]
},
"negotiated_type": {
Expand Down
1 change: 1 addition & 0 deletions schemas/in-network-rates/in-network-rates.xml
Original file line number Diff line number Diff line change
Expand Up @@ -334,6 +334,7 @@
<billing_class>
<enum>professional</enum>
<enum>institutional</enum>
<enum>both</enum>
</billing_class>
<negotiated_type>
<enum>negotiated</enum>
Expand Down

0 comments on commit c4e7430

Please sign in to comment.