Improving negotiated_type

[davidmuhlestein]

The negotiated_type field is problematic. Here are various issues:

• Despite definitions at https://github.com/CMSgov/price-transparency-guide/tree/develop-v2.0/schemas/in-network-rates#additional-notes-1, insurers are very inconsistent with how they use negotiated and fee schedule
• Some use only one, while others only use the other, and some use both, and it's very difficult to understand them
• When the type is percentage, it is very difficult to get close to an actual amount
• The type derived is very inconsistent and, at times, meaningless as the derived values are very different from any believable amount (ex: $500 for a DRG admission)

Here are some recommendations to improve negotiated_type:

1. Make clearer definitions for each of the individual types
2. Rename "fee schedule" to something that reflects that this is only for when the beneficiary has a different cost-sharing liability; examples are: "cost-sharing rate", "beneficiary reference rate" or something else.
3. Make it explicit that "fee schedule" should only be used if there is also a "negotiated" type and if it is different from the negotiated type
4. For the type "percentage", require the chargemaster billed rates to be included, or, rather than putting in the percentage, just require them to calculate the amount (i.e., percentage * chargemaster billed amount)
5. I don't know what to do with derived; sometimes they look pretty good, but I'm not sure how to fix the ones that are obviously wrong other than auditing the payer