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Cost table representation for adjustments

Is there a standard convention for representing adjustments to items in the COST table from the point of view of the Hospital system, or is the concept of adjustments to billed charges just the implicit difference between charges and payments?

Holt Oliver

I’d say the latter. If you think this needs agreement you should engage with THEMIS. That’s where conventions are set.

There is no convention guidance, but the cost table is able to support representation of positive and negative records for the same visit that add up to 0. Unfortunately, there is not much community experience in this domain.

Hi @George_Oliver ,

When you are referring to adjustments, are you referring to contractual adjustments after a payer adjudicates a claim? For example, you charge $100, the payer allows $80, the payer pays $70, the patient has a $10 coinsurance; so the hospital needs to the adjust the line item $20? If so, you can use the amount_allowed field and add $80 to the record. The adjustment will be the difference between the amount charged and the amount allowed (total_charge - amount_allowed - in the above example $100-$80 = $20 adjustment).

To complete the cost_table record for this example, you would add total_charge =$100, total_paid = $80, paid_by_payer = $70, paid_by_patient = $10, paid_by_patient_coinsurance = $10, amount_allowed = $80.

If your adjustment refers to something other than a contractual agreement, please describe and I can help you put it into the correct places.

I helped develop the cost_table so I know what numbers the cost table supports and have a good sense of what use cases this table supports. Happy to help!

There was work to transition cost table from wide to long form. See full thread here


Yes I remember Gowthan :slight_smile: I remember our call and wonder whatever happened to this!

The current documentation does not specify that the table is moving from wide to long (i.e. normalize). And the 5.4 specs still do not have the patient ID and dates - as your proposal states. I guess this proposal is not applicable to v5.4?

@George_Oliver my recommendation from my original post still stands as it corresponds to the current documentation of the Cost table. But, obviously it will need to be amended if @Gowtham_Rao proposal is accepted for v5.4.