filed_charge
What a hospital filed as its own standard charge for an inpatient admission, under 45 CFR 180. What-does-an-admission-cost is this tool. What a payer pays for a procedure is rate_position, and the two are separate tools on purpose. Groupers: MS-DRG and APR-DRG. code_type is required, because five DRG groupers sit in one column of this corpus and a code number means a different admission under each: one filer files 453 as a spinal fusion under MS-DRG and as a stroke under APR-DRG, in the same file. R-DRG and TRIS-DRG are not read, and every answer names them with their row counts so that reading two groupers is visibly a choice. severity is required when code_type is APR-DRG and refused otherwise. That grouper numbers a base condition and splits it four ways by severity of illness, all four sharing one description, and the four carry four different prices. MS-DRG has no such split. Where a filer wrote the grouper into the code itself, this tool reads it rather than guessing: every cell carries filed_code, the string exactly as filed, so MS471 and 471 sit side by side and the reading can be checked from the answer. Seven filers, each a health system rather than a hospital. No statistic across them is served at any number of rows, because one filer is roughly half the corpus and the smallest is a ten-thousandth of it, so a figure across them would be a figure about the largest one wearing a wider name. Each filer's own filing is served, named. Payer-identified filings are served with the payer name exactly as the hospital wrote it, in filed_payer_text, never in a field called payer. It is free text and never a payer slug: the same company appears under several spellings, some entries name a third-party administrator renting a network rather than the insurer, and one is a government programme. Passing an MRF payer slug is refused. The distinct strings behind an answer ship with it, with their counts, so the fragmentation is a figure rather than a warning. methodology rides on every payer-identified figure and decides what the figure is: a dollar filed under percent of total billed charges is a number the hospital computed from its own gross charge rather than a price observed anywhere, a case rate is one payment for a whole admission, and a per-diem row is priced by the day while this corpus holds no length of stay. Cells are never pooled across methodologies. Every cell carries two row counts: n after deduplicating on the full natural key, and n_rows_before_dedupe, what it started from. They differ because this corpus replicates, and serving only one of them would either hide a defect or state a count the corpus cannot support. Neither is a count of admissions, of patients or of payments. A filed charge is what the hospital published, not an adjudicated claim. No row behind these figures records that anything was paid, that a patient was billed this, or that a payer agreed to it. A code absent from one filer may be a code that filer's grouper edition does not define rather than an admission it does not price, and neither the file's schema version nor its vintage names the edition, so this world does not settle it.
Use this form for new arguments. Follow concrete links for known values. Fetch-only readers may be unable to submit new URLs.
Exact input contract
{
"additionalProperties": false,
"properties": {
"by_facility": {
"description": "Optional, and off unless you send it. True adds the facility cut: every facility of the filer at once, each with its own facility_rows and its own counterparty cells. A call that does not send it gets exactly the answer it got before, with no extra field on it, because the two grains are two different deduplications and a figure that moved under a caller who did not ask for it to move is a figure they cannot check. The count at that grain is facility_rows and is never n: n at filer grain comes off a key that carries no facility at all, facility_rows is what that same key leaves with the facility tuple added, so the per-facility counts sum to at least the filer's n and never to less.",
"type": "boolean"
},
"code": {
"description": "The DRG code, as the grouper numbers it. Leading zeros are part of the code.",
"type": "string"
},
"code_type": {
"description": "Which grouper the code belongs to. Required: a bare number is ambiguous between the groupers this corpus carries.",
"enum": [
"MS-DRG",
"APR-DRG"
],
"type": "string"
},
"filer": {
"description": "Optional. One health system. Omit it to get every filer that filed the code, each named.",
"enum": [
"cleveland-clinic",
"hca-medical-city",
"hss",
"mount-sinai",
"northwell",
"nyu-langone",
"vanderbilthealth-com"
],
"type": "string"
},
"severity": {
"description": "The APR-DRG severity of illness subclass. Required when code_type is APR-DRG and refused otherwise.",
"enum": [
"1",
"2",
"3",
"4"
],
"type": "string"
}
},
"required": [
"code",
"code_type"
],
"type": "object"
}