A percentage does not settle applicability

A percentage in a contract is not enough to decide that allowed-amount statistics are required. CMS describes an exception when a negotiated charge can be fully calculated and encoded as a dollar amount, with no further percentage or algorithm changing it.

This matters when reviewing rows that contain both a percentage and a dollar value. The first task is to understand what the published charge represents. Counting every such row as a confirmed reporting failure skips the applicability question.

Use broad candidate detection to find rows worth reviewing, then separate fully calculable dollar charges from charges subject to allowed-amount reporting. Document the decision and its evidence. Only then evaluate whether count, median and percentiles describe the relevant remittance history. A useful detector and a compliance verdict are different outputs.

Read the original research: When a zero count has a median.

Sources: CMS FAQ; CMS technical documentation.