> Notice how every item has a price that requires external information to understand:
> Per diem rates are paid for each day a patient is in the hospital. We need to know how long the patient will be in the hospital to know the total amount. > Rates for Cardiac Studies require knowing the price the hospital will bill in the future. The rate is essentially “44.8% of another unknown price,” which isn’t terribly helpful to a patient. > Radiology rates are based on an external price list that has to be looked up in an entirely different database. External rate lists are very common in health insurance but are not helpful unless you have access to the latest price list and can do the math yourself.
is where they stood out from their competitors, who typically had huge, and very wide database tables to capture this, but my ex-employer had written a DSL that allowed billing rules to be described with lookups and logic.