Adjustments may be required to reflect accuracy in the estimated costs of the diagnoses and procedures under consideration
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We are finalizing, with modification, our proposed definition of tenth (10th) percentile allowed amount in 180.20 as the 10th percentile of the total allowed amounts the hospital has historically received from a third party payer for an item or service for a time period no less than 12 months and no longer than 15 months prior to posting the machine-readable file
We also acknowledge that, in certain situations (for example, in the case of a new hospital, or a hospital contracting with a new payer organization), a hospital may have no historical claim remittance history from which to derive a median, 10th percentile, or 90th percentile allowed amount for a payer and plan
