Statistical & Public-Record Methodology

How BaseRate Health Calculates Fair Benchmarks & Verifies Hospital Data

Every price, quality metric, and financial-assistance benchmark on BaseRate Health is derived from public federal disclosures and reproducible statistical rules. Nothing is crowdsourced or invented.

1. Primary Federal & Public Data Sources

Each hospital and procedure record links six authoritative public datasets by CMS Certification Number (CCN), National Provider Identifier (NPI), Employer Identification Number (EIN), and geographic FIPS/CBSA codes:

1. Hospital Price Transparency Machine-Readable Files (45 CFR § 180)

Standardized gross charges, discounted self-pay cash rates, and payer-specific commercial negotiated rates published directly by hospitals. Every ingested file is recorded with its source URL, publication date, byte size, and SHA-256 cryptographic digest.

2. CMS Medicare Reference Fee Schedules (PFS, OPPS, IPPS & CLFS)

Geographically wage-adjusted Medicare allowed amounts for CPT/HCPCS outpatient procedures, clinical laboratory tests, and MS-DRG inpatient stays serve as our consistent public cost anchor.

3. CMS Hospital Care Compare & CDC NHSN Infection Surveillance

CMS overall 1–5 star ratings, HCAHPS patient-experience survey scores, timely emergency and sepsis care measures, 30-day mortality/readmission comparisons, Healthcare-Associated Infection Standardized Infection Ratios (`1.00` = national predicted baseline), and public CMS administrative enforcement logs.

4. IRS Form 990 Schedule H & CMS HCRIS Cost Reports (26 U.S.C. § 501(r))

Tax-exempt 501(c)(3) status, Federal Poverty Level (FPL) free and discounted care thresholds, net charity care as a share of operating expenses, and Amounts Generally Billed (AGB) benchmarks. Where hospital-specific CMS HCRIS look-back filings are matched, we label them explicitly; otherwise we display the illustrative national nonprofit peer median (`36.3%` of gross charges) and instruct patients to request the facility’s written Financial Assistance Policy (FAP).

5. CMS NPPES National Provider Registry (Freestanding Alternatives)

Geolocated independent Ambulatory Surgery Centers (ASCs), diagnostic imaging facilities, and clinical laboratories within 50 miles of hospital campuses.

6. U.S. Census ACS & HHS Federal Poverty Guidelines

Local median household income, uninsured population shares, and annual HHS poverty thresholds used to contextualize out-of-pocket affordability.

2. Modeled Fair Price: The BaseRate (`p10`, `p50`, `p90`)

The BaseRate (`p50`) is a modeled estimate of the fair commercial market price for a specific billing code at a specific hospital — anchored to the geographically adjusted Medicare rate, local wage/cost indices, and hospital peer characteristics (bed size, teaching status, rural/urban setting). Alongside the `p50` point estimate, we publish the `p10–p90` market interval (`High`, `Medium`, or `Low` confidence based on clean peer sample depth). Across held-out clean procedure benchmarks, roughly 80% of validated commercial medians fall inside the modeled `p10–p90` band.

3. Statistical Quarantine & VeriRate Integrity (`/100`)

Raw hospital MRF disclosures frequently contain placeholder tokens (e.g., `$0.01` or `$999,999`), unbundled per-diem totals filed on per-unit codes, or inverted gross-vs-cash schedules. Before computing medians or BaseRate comparisons, our ingestion pipeline applies strict statistical outlier and unit-consistency gates. Quarantined lines are suppressed rather than displayed as verified prices.

Each facility’s disclosure is summarized by a five-pillar VeriRate Scorecard (`/100`, tiered as `Verified`, `Corroborated`, `Partial`, or `Sparse`) measuring: (1) Provenance (schema & hash completeness), (2) Coherence (logical ordering between gross, negotiated, and self-pay rates), (3) Concordance (alignment with Medicare and regional peers), (4) Distribution (leading-digit statistical regularity), and (5) Self-Pay Clarity (published cash discount availability).

What the BaseRate Is Not

BaseRate benchmarks are statistical models built on public filings — not a medical bill, binding quote, insurance benefit determination, or legal/medical advice. Inpatient MS-DRG bundles and outpatient CPT codes reflect distinct clinical scopes, and HCPCS drug codes represent specific dosage units. Always confirm network status, clinical setting, and written Good Faith Estimates directly with your physician, hospital, and insurer. Have an updated MRF link? Review our Hospital Compliance & Correction Protocol.