Hospital Free Text Notes - Bucket Taxonomy

Source table: tq_dev.internal_dev_npattison.hospital_data_notes

Date: 2026-04-14

Source Table

The source table tq_dev.internal_dev_npattison.hospital_data_notes is a pre-aggregated view of the three free-text note fields from tq_production.hospital_data.hospital_rates. It groups rate rows by their distinct combination of additional_generic_notes, additional_payer_notes, negotiated_algorithm, revenue_code, and billing_code_type, filtering to rows where at least one note field is non-null. Each row includes a total_count representing the number of underlying rate rows in that group.

-- Simplified construction logic
SELECT
  additional_generic_notes,
  additional_payer_notes,
  negotiated_algorithm,
  revenue_code,
  billing_code_type,
  COUNT(*) AS total_count
FROM tq_production.hospital_data.hospital_rates
WHERE additional_generic_notes IS NOT NULL
   OR additional_payer_notes IS NOT NULL
   OR negotiated_algorithm IS NOT NULL
GROUP BY 1, 2, 3, 4, 5

Overview

Hospital v3 transparency files include three free-text fields that hospitals use to communicate reimbursement information not captured by the structured schema:

Field	Rows w/ Data	Description
additional_generic_notes	46.7M groups	General notes about rate methodology, data availability, and charge type labels
additional_payer_notes	3.2M groups	Payer-specific commentary on rates, plan exclusions, and reimbursement rules
negotiated_algorithm	13.3M groups	Algorithm/methodology descriptions for how the rate was derived or adjusted

Total: 54M distinct note groups covering 7.56B rate rows.

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Bucket Summary

#	Bucket	Description	Rate Rows	% of Total	Signal	Priority
1	Junk / No-Data	No historical data, zero payments, or insufficient remittance info	2.60B	34.4%	Noise	Low
2	Bundling / Packaging	Services bundled into DRG, APC, EAPG, or case rate payments	1.01B	13.3%	High	Medium
3	Percent-of-Charge	Rate defined as X% of billed or gross charges	1.00B	13.3%	High	Medium
4	Complex Algorithm	Multi-step formulas, conditional payment logic, hierarchical rules	880M	11.6%	Med-High	Medium
5	Carve-out Indicator	Services carved out of (or included in) package/case rates	403M	5.3%	High	High
6	Per-Diem Tiers	Step-down day structures, behavioral health per-diem bundling	241M	3.2%	High	High
7	Fee Schedule / APC	Methodology labels: APC, OPPS, EAPG, fee schedule references	215M	2.9%	Medium	Low
8	Rate Methodology Label	Generic rate type labels: FSC/BFG codes, "Per Service Unit Rate"	215M	2.8%	Low-Med	Low
9	Threshold / Outlier	Charge caps, outlier triggers, cost thresholds for alternate reimbursement	159M	2.1%	High	High
10	Stoploss / Lesser-of	Stoploss provisions and lesser-of clauses on total claim amounts	140M	1.9%	High	Done
11	Medicare/Medicaid Benchmark	Rates defined as X% of Medicare or Medicaid reimbursement	104M	1.4%	Medium	Medium
12	Multiple Procedure Logic	Bilateral/sequential procedure discounting rules	93M	1.2%	High	High
13	Gross Charge Type	Internal CDM/inventory labels (pharmacy, standard, location codes)	68M	0.9%	Low	Low
14	Not Covered / Exclusion	Plan exclusions, service/code combinations not covered	36M	0.5%	Medium	Low
15	Self-Pay Discounting	Self-pay contract pricing with IP/OP discount structures	31M	0.4%	Medium	Low
16	Transplant	Transplant-specific case rate rules and IP-only restrictions	27M	0.4%	High	High
17	Place of Service	Facility vs. non-facility rate differentiation	21M	0.3%	Medium	Low
18	Unclassified (long-tail)	Remaining notes not matching any bucket pattern	320M	4.2%	Mixed	-

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Percent-of-Fee-Schedule Patterns

Beyond simple percent-of-charge, notes reveal several distinct "% of X" reimbursement patterns. These are not just Medicare benchmarks - there are meaningful non-Medicare fee schedule references:

Pattern	Groups	Rate Rows	Key Signal
% of charges	5.6M	587M	Standard percent-of-billed/gross (bucket #3)
Other percent	2.2M	108M	Miscellaneous percentage references
% of Medicaid	18K	19.6M	Medicaid benchmark rates
% of Medicare	17K	17.7M	Medicare benchmark rates
% of line item charges	10K	14.0M	Per-line-item charge percentage
% of APC rate	117K	6.8M	Paid as a percent of APC - distinct from flat APC
Tiered % above threshold	462	4.2M	Reimbursement tiers: "24.14% of charges above $1.5M"
% of invoice cost	758	2.3M	Invoice-based: "70% of invoice when line > $2,500"
% of allowed	320	108K	Percent of allowed amount

Notable non-Medicare examples:

• Paid as a percent of APC rate - 3.2M rates across supplies (rev 278) and sterile supply (rev 272)
• Services are reimbursed as a percentage of line item charges - 2.2M rates, sometimes with sequestration note
• Reimbursement percentage applies to the first $1,500,000 of approved charges; Reimbursement will be 24.14% of approved charges above $1,500,000 - tiered structures with dollar thresholds
• Reimbursement is 70% of invoice when claim line is greater than $2,500 - conditional invoice-based pricing
• Payment at lesser of 100% of invoice cost or $1,150 per unit. Maximum payable number of units per item is 2. - invoice cost with unit caps

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Billing Code Type Distribution

Rates with notes are overwhelmingly CDM and HCPCS, but some buckets concentrate on specific code types:

Bucket	CDM	HCPCS	MS-DRG	HIPPS	APR-DRG
Per-Diem Tiers	123M	82M	15M	14M	411K
Stoploss / Lesser-of	54M	61M	12M	-	1.4M
Multiple Procedure	4.7M	88M	8K	-	-
Place of Service	-	17M	-	-	-
Transplant	15M	12M	356K	1K	22K

Takeaway: Multiple procedure logic and place of service are professional-fee (HCPCS) concepts. Per-diem tiers and stoploss have meaningful MS-DRG/HIPPS inpatient volume.

Revenue Code Concentration (High-Interest Buckets)

Bucket	Top Rev Codes	Interpretation
Carve-out	278 (180M), 272 (61M), 250 (21M), 636 (19M)	Supplies, implants, pharmacy, drugs
Per-Diem Tiers	278 (79M), 272 (29M), 250 (18M), 259 (11M)	Items bundled into per-diem
Transplant	278 (11M), 250 (3.3M), 272 (2.3M), 636 (2.1M)	Transplant supply/drug costs
Threshold/Outlier	278 (69M), 272 (16M), 361 (7.6M)	High-cost supplies + OR services
Multiple Procedure	360 (14M), 361 (10M), 750 (9.5M), 490 (9.4M)	OR, professional, ambulatory surgery
Stoploss	278 (38M), None (38M), 272 (8.4M), 637 (6.5M)	Broad - supplies + drugs

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Bucket Details & Examples

1. Junk / No-Data

2.60B rates (34.4%) | Signal: Noise

Notes indicating no historical data, zero payments, or insufficient remittance info. Largest bucket by far - not useful for rate intelligence. Heavily concentrated on rev code 278 (supplies).

Example 1 - Rev 278 / CDM

generic_notes: Case count under development 132.9M rates

Example 2 - Rev 278 / CDM

generic_notes: No services performed during 15-month lookback period. 124.7M rates

Example 3 - Rev 278 / CDM

generic_notes: 0 remits to support allowed amounts 69.5M rates

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2. Bundling / Packaging

1.01B rates (13.3%) | Signal: High

Describes what's bundled into DRG, APC, EAPG, or case rate payments. Tells us which services are NOT separately reimbursed and which payment vehicle they roll into. The algorithm field is the primary carrier here.

Example 1 - Rev 278 / CDM

algorithm: Reimbursement bundled into MS-DRG where appropriate 25.4M rates

Example 2 - Rev 278 / CDM

generic_notes: Packaged/Bundled or Carrier Priced Code is not considered to be a service package on its own, but can be part of a service package and algorithm: Bundled into Service Package 19.2M rates

Example 3 - Rev 278 / CDM

algorithm: Reimbursement bundled into APC where appropriate 17.7M rates

Example 4 - Rev 270 / CDM

algorithm: Reimbursement bundled into MS-DRG where appropriate 11.3M rates

Example 5 - Rev 272 / CDM

generic_notes: Packaged/Bundled or Carrier Priced Code is not considered to be a service package on its own, but can be part of a service package and algorithm: Bundled into Service Package 10.3M rates

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3. Percent-of-Charge Methodology

1.00B rates (13.3%) | Signal: High

Explicit percent-of-charge rate methodology. Includes specific percentages (95%, 97%, 90%, 60%, etc.) and sometimes conditional caps ("if allowed exceeds billed, cap at billed").

Example 1 - No rev / CDM

generic_notes: percent of billed charges Calculated as 95% of gross charge. Zero final payments for the item or service in the 12 months prior to posting the file. 95% of billed. If the allowed amount exceeds the billed amount, it will be capped at the billed amount. 31.5M rates

Example 2 - No rev / CDM

generic_notes: percent of billed charges Calculated as 97% of gross charge. Zero final payments for the item or service in the 12 months prior to posting the file. 97% of billed. If the allowed amount exceeds the billed amount, it will be capped at the billed amount. 12.8M rates

Example 3 - Rev 278 / CDM

generic_notes: percent of billed charges Calculated as 95% of gross charge. Zero final payments for the item or service in the 12 months prior to posting the file. 20.2M rates

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4. Complex Algorithm

880M rates (11.6%) | Signal: Medium-High

Rich contracting logic - conditional payment logic, multi-step formulas, hierarchical reimbursement rules. The most text-dense bucket. "OTHER PAY METHOD" is the largest single note (726M rates combined CDM+HCPCS), but beneath it lie genuinely complex algorithms.

Example 1 - No rev / CDM

generic_notes: OTHER PAY METHOD 407.7M rates

Example 2 - No rev / HCPCS

payer_notes: Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The estimated allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm. algorithm: Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements. 13.1M rates

Example 3 - Rev 278 / CDM

algorithm: 60% of billed. Applicable billed amount defined as the total billed amount. Accumulated reimbursement defined as the sum of reimbursement for the current line and claim lines that were already priced by a method that includes this accumulation logic. 2.3M rates

Example 4 - No rev / HCPCS

payer_notes: contract indicates payment as: algorithm algorithm: If ( Current Amount = 0 ) Then: Manual Review/Entry: Flag for review : Unlisted services in MRA Fee Schedule, accept work comp allowed. 1.7M rates

Example 5 - No rev / HCPCS

algorithm: [Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE] 1.3M rates

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5. Carve-out Indicator

403M rates (5.3%) | Signal: High | Priority: High

Identifies services carved out of (or included in) package rates. Key for understanding implant/drug pricing that is reimbursed separately from DRG/case rate payments. Concentrates on supply/implant (278), sterile supply (272), and pharmacy (250) revenue codes. Two main patterns: "% CHARGE (W/O CARVE OUTS)" and "included in case rate" conditional logic.

Example 1 - Rev 278 / CDM

generic_notes: % CHARGE (W/O CARVE OUTS) - REV CODE LINKED TO CDM 119.0M rates

Example 2 - No rev / HCPCS

payer_notes: Reimbursement for this supply is included in case rate because service is part of an Outpatient Surgery, Emergency Room visit, or Inpatient stay. 34.5M rates

Example 3 - Rev 278 / None

payer_notes: Included in case rate when provided in an inpatient setting. 5.3M rates

Example 4 - No rev / HCPCS

payer_notes: Reimbursement is included in case rate if service is part of an Outpatient Surgery, Emergency Room visit, or Inpatient stay. For Radiology - reimbursement is included in the case rate if service is part of an Outpatient Surgery or Inpatient Stay. algorithm: percent of total billed charges 545K rates

Example 5 - No rev / HCPCS

payer_notes: Outpatient Surgery - case rate is inclusive of all ancillary services. If multiple surgeries - Most expensive surgery is reimbursed at 100% of the plan rate; Additional surgeries within claim are reimbursed at 50% of the plan rate. 431K rates

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6. Per-Diem Tiers

241M rates (3.2%) | Signal: High | Priority: High

Step-down per-diem rate structures (Days 1-3 vs Days 4+), per-diem bundling, behavioral health per-diem specifics, and day-based threshold triggers. Contains rate structure info NOT captured in the standard dollar fields. Concentrated on MS-DRG code type (inpatient).

Example 1 - No rev / MS-DRG

payer_notes: Day 1 rate - Inpatient service based on DRG and length of stay - case rate is inclusive of all facility services. For DRGs 790-795 - if for well baby visit - reimbursement is $0. 59.7K rates

Example 2 - No rev / MS-DRG

generic_notes: Days 13+ are paid at $6,670 per diem per day payer_notes: Days 13+ are paid at $6,670 per diem per day 27.0K rates

Example 3 - No rev / MS-DRG

payer_notes: Days 1 - 2. If billable gross charges exceed threshold of $599,404.00, reimbursement will be $5,392 per diem instead of the contracted rate. 15.2K rates

Example 4 - Rev 278 / CDM

algorithm: Reimbursement bundled into MS-DRG or per diem rate where appropriate 14.4M rates

Example 5 - Rev 278 / CDM

algorithm: Reimbursement bundled into per diem rate when provided in conjunction with a covered behavioral health stay 4.7M rates

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7. Fee Schedule / APC

215M rates (2.9%) | Signal: Medium

Methodology labels identifying the reimbursement framework: APC, OPPS, EAPG, fee schedules. Useful for understanding HOW the rate was derived, but less novel than content-rich buckets.

Example 1 - No rev / HCPCS

payer_notes: APC 12.1M rates

Example 2 - No rev / HCPCS

generic_notes: FEE SCHEDULE - CPT/HCPCS IN FEE SCHEDULE 11.9M rates

Example 3 - No rev / CDM

generic_notes: FEE SCHEDULE - CPT/HCPCS LINKED TO CDM 8.8M rates

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8. Rate Methodology Label

215M rates (2.8%) | Signal: Low-Medium

Generic rate type labels: "Per Service Unit Rate", fee schedule codes (FSC/BFG), "Physician", "Supply Charge". These label the rate type but don't add deep reimbursement logic.

Example 1 - No rev / CDM

generic_notes: FSC: 184; BFG: 37 61.2M rates

Example 2 - No rev / HCPCS

generic_notes: Per Service Unit Rate 29.0M rates

Example 3 - No rev / HCPCS

generic_notes: Physician 8.3M rates

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9. Threshold / Outlier

159M rates (2.1%) | Signal: High | Priority: High

Outlier thresholds, charge caps per revenue code, and high-cost case triggers. These define when a rate switches from standard to outlier reimbursement. Contains specific dollar thresholds, carveout-charge interaction logic, and implant exclusion rules.

Example 1 - Rev 278 / HCPCS

payer_notes: OPPS APC; APC Pricing (Adjusted APC Price: 0.00) and; Prc Ext - HB XR PRC - Medicare OPPS Outlier; Note: This line does not qualify for an outlier under OPPS. 843K rates

Example 2 - Rev 278 / CDM

payer_notes: % of Billed Charges. Paid In Addition to Other Negotiated Rates for a listed individual billing code only, when the sum of the listed individual billing code claim lines is greater than $999.99. Otherwise treat as ancillary charge. algorithm: Lesser of: [(Qualifying Line Item Charges > threshold X Contract %) + ((Carveout Charges > threshold) X Carveout %) + (Contracted rate for any additional allowable services)] or [(Qualifying Line Item Charge) + (Carveout Charges > threshold) + (Gross charges for...)] 354K rates

Example 3 - Rev 278 / CDM

payer_notes: Implant cost not considered in outlier limit. Revenue Code 274-278 are excluded 352K rates

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10. Stoploss / Lesser-of

140M rates (1.9%) | Signal: High | Priority: Already explored

Stoploss provisions and lesser-of clauses. Previously investigated in the provisions work. Found in algorithm and payer notes fields. Contains specific dollar thresholds and percentage-based lesser-of logic.

Example 1 - Rev 278 / CDM

payer_notes: This service is paid as a percentage of charge at the line level. This service may be paid in addition to other services except surgery. algorithm: Contracted % x Line Charge + Lesser of: (Other Contracted Rates or Remaining Charges) 1.5M rates

Example 2 - Rev 278 / CDM

algorithm: Payment at lesser of 106.7% invoice cost or $970 per unit. Maximum payable number of units per item is 2. 1.3M rates

Example 3 - Rev 490 / HCPCS

payer_notes: . MPL 100/50/25% all add ons apply, and lesser of 100% of billed charges 1.5M rates

Example 4 - No rev / HCPCS

generic_notes: Per Service Unit Rate payer_notes: Can be subject to lesser of provisions, Line item charges and subsequent payments can be subject to service bundling. 1.2M rates

Example 5 - Rev 278 / HCPCS

payer_notes: For claims with one or more procedures not listed on the outpatient procedure fee schedule or claims with no listed procedure... algorithm: If billed with one or more unlisted procedures or no listed procedures, then [(Lesser of: (Listed Diagnostic and Therapeutic fee schedule rates X Contracted % X Billed Units) + (Listed Hospital Drug Rates X Billed Units X Contracted %) or their respective line charges)] 1.1M rates

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11. Medicare/Medicaid Benchmark

104M rates (1.4%) | Signal: Medium

Rates explicitly defined as a percentage of Medicare or Medicaid reimbursement. Predominantly 100% of Medicare, but includes varied percentages (102%, non-100% Medicaid) and notes about OPPS packaging edge cases.

Example 1 - No rev / HCPCS

generic_notes: 100 PERCENT OF MEDICARE RATE - % OF MEDICARE RATE - CPT/HCPCS IN MEDICARE REPLACEMENT CONTRACT 2.6M rates

Example 2 - No rev / HCPCS

payer_notes: 100.00% of Medicare Rates 1.8M rates

Example 3 - Rev 637 / None

payer_notes: Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 algorithm: Percent of Medicaid Reimbursement + Reimbursement Rate 100.00 1.5M rates

Example 4 - Rev 637 / None

payer_notes: Payer contract is 102.00% of Medicare but standard charge associated HCPCS and/or revenue code is invalid and therefore, not paid under Medicare OPPS payment. 564K rates

Example 5 - Rev 490 / HCPCS

payer_notes: 100 Percent of Medicaid APG. 639K rates

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12. Multiple Procedure Logic

93M rates (1.2%) | Signal: High | Priority: High

Bilateral and sequential procedure discounting rules. Almost entirely HCPCS (professional fees). Concentrated on OR/procedure revenue codes (360, 361, 490, 499, 750). The same payer note appears across all procedure-related rev codes, suggesting plan-level rules.

Example 1 - Rev 490 / HCPCS

payer_notes: The rate (in dollars) may be further adjusted for multiple procedure logic. 7.6M rates

Example 2 - Rev 360 / HCPCS

payer_notes: The rate (in dollars) may be further adjusted for multiple procedure logic. 7.6M rates

Example 3 - Rev 750 / HCPCS

payer_notes: The rate (in dollars) may be further adjusted for multiple procedure logic. 7.6M rates

Example 4 - Rev 481 / HCPCS

payer_notes: The rate (in dollars) may be further adjusted for multiple procedure logic. 5.4M rates

Example 5 - Rev 490 / HCPCS

payer_notes: Additional Notes: The rate (in dollars) may be further adjusted for multiple procedure logic. 1.3M rates

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13. Gross Charge Type

68M rates (0.9%) | Signal: Low

Internal CDM/inventory labels - "Pharmacy", "Standard", inventory location codes. Hospital-internal metadata, not useful for rate intelligence.

Example 1 - Rev 278 / CDM

generic_notes: Gross Charge Type: Inv Loc: 907; from OR location 876, pulled from HB location 3.1M rates

Example 2 - Rev 250 / CDM

generic_notes: Gross Charge Type: Pharmacy 2.6M rates

Example 3 - Rev 278 / CDM

generic_notes: Gross Charge Type: standard 967K rates

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14. Not Covered / Exclusion

36M rates (0.5%) | Signal: Medium

Plan exclusions - service/code combination not covered by the payer plan.

Example 1 - Rev 637 / None

payer_notes: Not paid by the payer plan + No services performed during 15-month lookback period 5.8M rates

Example 2 - Rev 278 / CDM

generic_notes: CODE COMBINATION NOT COVERED BY THIS PLAN 3.2M rates

Example 3 - Rev 278 / HCPCS

generic_notes: CODE COMBINATION NOT COVERED BY THIS PLAN 3.0M rates

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15. Self-Pay Discounting

31M rates (0.4%) | Signal: Medium

Self-pay contract pricing - IP/OP discounts with min/max logic. Almost entirely rev code None (29M of 31M), suggesting these are posted at the plan level rather than per-service.

Example 1 - No rev / CDM

generic_notes: IP/OP DISCOUNT BASED ON SELF PAY CONTRACT(S). PAYOR NEGOTIATED RATE BASED ON OP ALL. MIN/MAX BASED ON ALTERNATE BILL CODE. 3.8M rates

Example 2 - No rev / CDM

generic_notes: IP/OP DISCOUNT BASED ON SELF PAY CONTRACT(S). PAYOR NEGOTIATED RATE BASED ON OP ALL. MIN/MAX BASED ON SAME BILLABLE CODE. 3.3M rates

Example 3 - No rev / CDM

generic_notes: IP/OP DISCOUNT BASED ON SELF PAY CONTRACT(S). PAYOR NEGOTIATED RATE BASED ON IP ALL. MIN/MAX BASED ON ALTERNATE BILL CODE. 2.1M rates

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16. Transplant

27M rates (0.4%) | Signal: High | Priority: High

Transplant-specific case rate and reimbursement rules. Concentrated on supply/implant (278), pharmacy (250), and sterile supply (272). Three main patterns: "inpatient only" restriction, "bundled into case rate for covered organ transplant," and "bundled for approved transplant stay."

Example 1 - Rev 278 / CDM

payer_notes: Transplant services reimbursed for inpatient services only. 3.9M rates

Example 2 - Rev 278 / CDM

algorithm: Reimbursement bundled into case rate when provided in conjunction with covered organ transplant 857K rates

Example 3 - Rev 250 / CDM

payer_notes: Transplant services reimbursed for inpatient services only. 732K rates

Example 4 - Rev 250 / CDM

algorithm: Reimbursement bundled into case rate when provided in conjunction with approved transplant stay 600K rates

Example 5 - Rev 636 / CDM

payer_notes: Transplant services reimbursed for inpatient services only. 418K rates

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17. Place of Service

21M rates (0.3%) | Signal: Medium

Facility vs. non-facility rate differentiation. 100% HCPCS - this is a professional fee concept distinguishing where the service is rendered.

Example 1 - No rev / HCPCS

payer_notes: Rate applies to facility place of service 7.8M rates

Example 2 - No rev / HCPCS

payer_notes: Rate applies to non-facility place of service 7.6M rates

Example 3 - No rev / HCPCS

payer_notes: Non-Facility. 743K rates

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Recommended Deep-Dive Priority

Based on signal quality, novelty (information not available in structured fields), and business value:

Priority	Bucket	Why
1	Per-Diem Tiers	Step-down day structures (Days 1-2 vs 13+) are rate structure info not in dollar fields. Includes charge-threshold triggers and behavioral health specifics.
2	Carve-out Indicators	Identifies what's carved out of package rates - directly relevant to implant/drug pricing. Contains conditional setting-based logic (IP vs OP vs ER).
3	Transplant	Stated priority. Scoped (27M rates), concentrated on supplies/drugs. Three distinct patterns: IP-only, organ transplant case rate, approved transplant stay.
4	Threshold / Outlier	Charge caps, carveout-charge interaction formulas, and implant exclusion rules. Dollar thresholds could extend stoploss work.
5	Multiple Procedure Logic	Bilateral/sequential discounting rules. Same payer note across all OR rev codes suggests plan-level extraction opportunity.
6	Complex Algorithm	Richest text, hardest to extract. 880M rates of contracting logic. Sub-bucket: accumulation-based reimbursement (% of billed with running totals).
7	% of Fee Schedule	Non-Medicare benchmarks (% of APC, % of invoice cost, tiered % above threshold) are a distinct signal from simple percent-of-charge.

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Classification SQL

The full CASE WHEN classification logic used to bucket these notes uses keyword matching via LOWER() + LIKE on all three note fields, with priority ordering (stoploss > transplant > per-diem > carve-out > ... > junk > unclassified). Classification rate: 95.8% of all rate rows.