A price and a statistic answer different questions

A contractual dollar amount answers what a payer-specific negotiated charge is. A historical median answers what the underlying allowed-amount history shows. Identical numbers do not make those questions interchangeable.

In the public-file example behind our latest research, the negotiated dollar amount and median both read $19,075.94. The allowed-amount count was zero, both percentiles were blank, and a note described zero service instances in the preceding 15 months. That combination is a source-data question, not proof that the negotiated price is wrong.

Start with the charge method and its applicability. A fully calculable dollar charge can be outside the allowed-amount reporting requirement. Where the statistics are required, trace them to remittance history. The useful review question is: what evidence supports this number in this field?

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

Sources: CMS FAQ; CMS technical documentation.