Version: Canary - 2.3 🚧

v2_3_1

Generated: 2026-01-08 10:55:23

Overview

This analysis examines the accuracy of canonical rates by analyzing scoring patterns and identifying potential outliers based on Medicare rate comparisons.

1. Outlier Score Analysis

Records with Outlier Canonical Rate Score

Total Records with canonical_rate_score = 1 (outliers): 105,135,319

Click to see SQL

            SELECT COUNT(*) as outlier_score_count
            FROM tq_dev.internal_dev_csong_cld_v2_3_1.prod_combined_all
            WHERE canonical_rate_score = 1
            

2. cbsa Medicare Rate Outliers

Rates vs cbsa Medicare Rates

Total Rates: 575,351,265 records

provider_type	bill_type	count	below_80pct_count	above_15x_count
Hospital	Outpatient	241,524,845	20,928,101	3,809,955
Physician Group	Professional	239,491,177	43,630,881	0
Hospital	Inpatient	63,574,712	0	0
ASC	Outpatient	21,824,840	3,228,454	379,986
Laboratory	Professional	6,923,497	3,249,350	0
Imaging Center	Professional	2,012,194	232,840	824

Click to see SQL

            SELECT
                provider_type,
                bill_type,
                COUNT(*) as count,
                COUNT(CASE WHEN canonical_rate < 0.8 * cbsa_avg_medicare_rate THEN 1 END) as below_80pct_count,
                COUNT(CASE WHEN canonical_rate > 15 * cbsa_avg_medicare_rate THEN 1 END) as above_15x_count
            FROM tq_dev.internal_dev_csong_cld_v2_3_1.prod_combined_all
            WHERE canonical_rate_score > 1
            GROUP BY provider_type, bill_type
            ORDER BY count DESC
            

3. Medicare Rate Outliers

Rates vs Facility-Specific Medicare Rates

Total Rates: 575,351,265 records

provider_type	bill_type	count	below_80pct_count	above_15x_count
Hospital	Outpatient	241,524,845	20,774,154	3,816,962
Physician Group	Professional	239,491,177	43,630,881	0
Hospital	Inpatient	63,574,712	425,753	142
ASC	Outpatient	21,824,840	3,083,995	456,713
Laboratory	Professional	6,923,497	3,249,350	0
Imaging Center	Professional	2,012,194	232,840	824

Click to see SQL

            SELECT
                provider_type,
                bill_type,
                COUNT(*) as count,
                COUNT(CASE WHEN canonical_rate < 0.8 * medicare_rate THEN 1 END) as below_80pct_count,
                COUNT(CASE WHEN canonical_rate > 15 * medicare_rate THEN 1 END) as above_15x_count
            FROM tq_dev.internal_dev_csong_cld_v2_3_1.prod_combined_all
            WHERE canonical_rate_score > 1
            GROUP BY provider_type, bill_type
            ORDER BY count DESC
            

4. Canonical Rate Score Distribution

Distribution of Canonical Rate Scores

canonical_rate_score	record_count	percentage
0	2,694,565,272	80.0%
1	105,135,319	3.0%
2	67,000,930	2.0%
3	278,874,281	8.0%
4	199,988,285	6.0%
5	29,487,769	1.0%

Click to see SQL

            SELECT
                canonical_rate_score,
                COUNT(*) as record_count,
                ROUND(1.000 * COUNT(*) / SUM(COUNT(*)) OVER(), 2) as percentage
            FROM tq_dev.internal_dev_csong_cld_v2_3_1.prod_combined_all
            GROUP BY canonical_rate_score
            ORDER BY canonical_rate_score
            

4.1. Canonical Rate Score Distribution by Provider Type

Distribution of Canonical Rate Scores by Provider Type

provider_type	canonical_rate_score	record_count	percentage
ASC	0	190,205,338	88.0%
ASC	1	3,162,192	1.0%
ASC	2	174,329	0.0%
ASC	3	241,422	0.0%
ASC	4	21,409,089	10.0%
Hospital	0	833,273,670	70.0%
Hospital	1	55,827,670	5.0%
Hospital	2	20,852,845	2.0%
Hospital	3	85,345,605	7.0%
Hospital	4	172,871,571	14.0%
Hospital	5	26,029,536	2.0%
Imaging Center	0	50,674,170	93.0%
Imaging Center	1	1,801,874	3.0%
Imaging Center	2	46	0.0%
Imaging Center	3	196	0.0%
Imaging Center	4	2,011,952	4.0%
Laboratory	0	28,285,284	80.0%
Laboratory	1	185,877	1.0%
Laboratory	2	979,535	3.0%
Laboratory	3	2,224,877	6.0%
Laboratory	4	364,218	1.0%
Laboratory	5	3,354,867	9.0%
Physician Group	0	1,592,126,810	85.0%
Physician Group	1	44,157,706	2.0%
Physician Group	2	44,994,175	2.0%
Physician Group	3	191,062,181	10.0%
Physician Group	4	3,331,455	0.0%
Physician Group	5	103,366	0.0%

Click to see SQL

            SELECT
                provider_type,
                canonical_rate_score,
                COUNT(*) as record_count,
                ROUND(1.000 * COUNT(*) / SUM(COUNT(*)) OVER(PARTITION BY provider_type), 2) as percentage
            FROM tq_dev.internal_dev_csong_cld_v2_3_1.prod_combined_all
            GROUP BY provider_type, canonical_rate_score
            ORDER BY provider_type, canonical_rate_score
            

5. Extreme Rate Ratios by Code Combination

Code Combinations with Most Rates < 0.2x Medicare

Top 20 provider_type, bill_type, billing_code combinations with the most rates below 20% of Medicare rates:

provider_type	bill_type	billing_code	total_records	below_20pct_count	below_20pct_percentage
Hospital	Inpatient	795	39,433	92	0.0%
Hospital	Inpatient	0640-1	36,158	55	0.0%
Hospital	Inpatient	0640-2	36,239	47	0.0%
Hospital	Inpatient	730	33,657	45	0.0%
Hospital	Inpatient	298	28,741	42	0.0%
Hospital	Inpatient	833	37,852	41	0.0%
Hospital	Inpatient	284	36,028	39	0.0%
Hospital	Inpatient	724	31,089	37	0.0%
Hospital	Inpatient	807	42,728	36	0.0%
Hospital	Inpatient	292	44,569	36	0.0%
Hospital	Inpatient	916	39,548	36	0.0%
Hospital	Inpatient	311	40,272	35	0.0%
Hospital	Inpatient	313	40,620	35	0.0%
Hospital	Inpatient	950	41,230	35	0.0%
Hospital	Inpatient	310	44,186	35	0.0%
Hospital	Inpatient	103	40,360	34	0.0%
Hospital	Inpatient	316	39,158	34	0.0%
Hospital	Inpatient	156	37,056	34	0.0%
Hospital	Inpatient	761	36,603	34	0.0%
Hospital	Inpatient	566	38,561	34	0.0%

Click to see SQL

            SELECT
                provider_type,
                bill_type,
                billing_code,
                COUNT(*) as total_records,
                COUNT(CASE WHEN canonical_rate < 0.2 * medicare_rate THEN 1 END) as below_20pct_count,
                ROUND(1.000 * COUNT(CASE WHEN canonical_rate < 0.2 * medicare_rate THEN 1 END) / COUNT(*), 2) as below_20pct_percentage
            FROM tq_dev.internal_dev_csong_cld_v2_3_1.prod_combined_all
            WHERE canonical_rate_score > 1
                AND medicare_rate IS NOT NULL
                AND medicare_rate > 0
            GROUP BY provider_type, bill_type, billing_code
            HAVING COUNT(CASE WHEN canonical_rate < 0.2 * medicare_rate THEN 1 END) > 0
            ORDER BY below_20pct_count DESC, below_20pct_percentage DESC
            LIMIT 20
            

Code Combinations with Most Rates > 10x Medicare

Top 20 provider_type, bill_type, billing_code combinations with the most rates above 10x Medicare rates:

provider_type	bill_type	billing_code	total_records	above_10x_count	above_10x_percentage
Hospital	Outpatient	72125	53,564	22,512	42.0%
Hospital	Outpatient	72131	53,601	22,113	41.0%
Hospital	Outpatient	72128	53,246	21,750	41.0%
Hospital	Outpatient	71250	53,841	21,716	40.0%
Hospital	Outpatient	70486	53,775	21,142	39.0%
Hospital	Outpatient	70450	54,154	20,945	39.0%
Hospital	Outpatient	74150	52,753	20,838	40.0%
Hospital	Outpatient	72192	53,361	20,797	39.0%
Hospital	Outpatient	70480	52,900	20,775	39.0%
Hospital	Outpatient	73200	52,667	20,734	39.0%
Hospital	Outpatient	73700	52,632	20,533	39.0%
Hospital	Outpatient	70490	52,864	20,230	38.0%
Hospital	Outpatient	37182	37,519	19,849	53.0%
Hospital	Outpatient	76390	42,240	19,511	46.0%
Hospital	Outpatient	62284	37,714	19,302	51.0%
Hospital	Outpatient	71275	53,827	18,934	35.0%
Hospital	Outpatient	74170	52,836	18,150	34.0%
Hospital	Outpatient	70498	53,416	17,953	34.0%
Hospital	Outpatient	70496	53,440	17,767	33.0%
Hospital	Outpatient	75635	51,806	17,760	34.0%

Click to see SQL

            SELECT
                provider_type,
                bill_type,
                billing_code,
                COUNT(*) as total_records,
                COUNT(CASE WHEN canonical_rate > 10 * medicare_rate THEN 1 END) as above_10x_count,
                ROUND(1.000 * COUNT(CASE WHEN canonical_rate > 10 * medicare_rate THEN 1 END) / COUNT(*), 2) as above_10x_percentage
            FROM tq_dev.internal_dev_csong_cld_v2_3_1.prod_combined_all
            WHERE canonical_rate_score > 1
                AND medicare_rate IS NOT NULL
                AND medicare_rate > 0
            GROUP BY provider_type, bill_type, billing_code
            HAVING COUNT(CASE WHEN canonical_rate > 10 * medicare_rate THEN 1 END) > 0
            ORDER BY above_10x_count DESC, above_10x_percentage DESC
            LIMIT 20
            

Overview​

1. Outlier Score Analysis​

Records with Outlier Canonical Rate Score​

2. cbsa Medicare Rate Outliers​

Rates vs cbsa Medicare Rates​

3. Medicare Rate Outliers​

Rates vs Facility-Specific Medicare Rates​

4. Canonical Rate Score Distribution​

Distribution of Canonical Rate Scores​

4.1. Canonical Rate Score Distribution by Provider Type​

Distribution of Canonical Rate Scores by Provider Type​

5. Extreme Rate Ratios by Code Combination​

Code Combinations with Most Rates < 0.2x Medicare​

Code Combinations with Most Rates > 10x Medicare​

On this page:

Overview

1. Outlier Score Analysis

Records with Outlier Canonical Rate Score

2. cbsa Medicare Rate Outliers

Rates vs cbsa Medicare Rates

3. Medicare Rate Outliers

Rates vs Facility-Specific Medicare Rates

4. Canonical Rate Score Distribution

Distribution of Canonical Rate Scores

4.1. Canonical Rate Score Distribution by Provider Type

Distribution of Canonical Rate Scores by Provider Type

5. Extreme Rate Ratios by Code Combination

Code Combinations with Most Rates < 0.2x Medicare

Code Combinations with Most Rates > 10x Medicare