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Rate Selection: Hospital HCPCS/Rev Code

0
total_count660654388
multiple_rev_codes_count53113037
multiple_rev_codes_with_rate_diff_count8757320

8757320 / 660654388 = ~1.32%

HCPCS posted with multiple revenue codes that have different negotiated dollar amounts represent a small portion of hospital MRF rates.

WITH
df AS (
SELECT
payer_id,
provider_id,
setting,
billing_class,
plan_name,
billing_code,
COUNT(DISTINCT COALESCE(revenue_code, '')) AS rev_code_count,
MIN(negotiated_dollar) AS min_rate,
MAX(negotiated_dollar) AS max_rate,
MAX(negotiated_dollar) - MIN(negotiated_dollar) AS rate_diff
FROM tq_production.hospital_data.hospital_rates
WHERE payer_class_name = 'Commercial'
AND billing_code_type = 'HCPCS'
GROUP BY 1,2,3,4,5,6
)
SELECT
COUNT(*) AS total_count,
SUM(
CASE WHEN rev_code_count > 1 THEN 1 ELSE 0 END
) AS multiple_rev_codes_count,
SUM(
CASE
WHEN rev_code_count > 1
AND rate_diff > 0
THEN 1 ELSE 0 END
) AS multiple_rev_codes_with_rate_diff_count
FROM df