Inpatient Rehabilitation Facility PPS Rate Settings 2017

$79 / year

This dataset contains the information about the Inpatient Rehabilitation Facilities (IRFs) Prospective Payment System (PPS) Rate Settings for fiscal year 2017. This file contains data for each of the 1,133 inpatient rehabilitation facilities used to estimate the policy updates in the final inpatient rehabilitation prospective payment system regulation.

Complexity

Inpatient rehabilitation is for patients who require intensive, interdisciplinary rehabilitation services. Such inpatient programs are designed to improve function and promote each patient’s highest degree of independence. IRFs are free standing rehabilitation hospitals and rehabilitation units in acute care hospitals. They provide an intensive rehabilitation program and patients who are admitted must be able to tolerate three hours of intense rehabilitation services per day. CMS collects patient assessment data only on Medicare Part A fee-for service patients.
These facilities are exempt from the Medicare Hospital PPS and are paid under the IRF Prospective Payment System effective 1/1/2002. In order to be paid under the IRF PPS, they must submit the IRF-PAI (Patient Assessment Instrument). The IRF-PAI is the third patient assessment instrument currently utilized by Centers for Medicare & Medicaid Services (CMS) (the other two are the Minimum Data Set (MDS) in nursing homes and the Outcome and Assessment Information Set (OASIS) in home health agencies. The IRF PPS will utilize information from a patient assessment instrument (IRF PAI) to classify patients into distinct groups based on clinical characteristics and expected resource needs. Separate payments are calculated for each group, including the application of case and facility level adjustments.

Date Created

2017

Last Modified

2017-05-03

Version

2017-05-03

Update Frequency

Annual

Temporal Coverage

N/A

Spatial Coverage

USA

Source

John Snow Labs => Centers for Medicare and Medicaid Services (CMS)

Source License URL

John Snow Labs Standard License

Source License Requirements

None

Source Citation

N/A

Keywords

Inpatient Rehabilitation Hospitals, Inpatient Rehabilitation Criteria, IRF Rehabilitation Facility

Other Titles

Prospective Payment System in Healthcare, Acute Rehabilitation Facility, Hospital Inpatient Quality Reporting Program

Name Description Type Constraints
Provider_IDCenter for Medicare & Medicaid Services (CMS) certification number (CCN). Identification number of the facility within the CMS dataset. The CCN for providers and suppliers is a 6 digit number. The first 2 digits identify the State in which the provider is located.The last 4 digits identify the type of facility.integerrequired : 1 level : Nominal
Number_of_DischargesIndicates the Number of Medicare beneficiary discharges from the FY 2015 analysis file.integerlevel : Nominal
Cost_to_Charge_RatioIndicates the cost to charge ratio Obtained from the March 2016 update of the Provider Specific File.numberrequired : 1 level : Ratio
Wage_IndexIndicates the FY 2017 CBSA-based labor market designations from the FY 2016 hospital pre-reclassification pre-floor hospital wage data.numberrequired : 1 level : Ratio
Is_Facility_RuralIndicates whether the facility is classified as a rural facility or not based on the State and County Code obtained from the Online Survey, Certification, and Reporting (OCSAR) system.booleanrequired : 1
Disproportionate_ShareIndicates the disproportionate share Obtained from the March 2016 update of the Provider specific file.numberrequired : 1 level : Ratio
Census_RegionIndicates the cencus region of he facility. State location obtained from the provider number and matched with the census region codes. There are 9 census regions encompassing IRFs including: East North, East South, Middle Atlantic, Mountain, New England, Pacific, South Atlantic, West North, and West South.integerrequired : 1 level : Nominal
Type_of_ControlIndicates the type of control of the facility obtained from the online Survey, Certification, and Reporting (OSCAR) system.stringmaxLength : 1
Teaching_StatusNumber of interns and residents divided by average daily census. Note that the information contained in this rate-setting file will not be used to determine whether an IRF qualifies for the teaching status adjustment or the amount of payment the IRF may or may not receive; the IRF's Medicare Administrative Contractor (MAC) will make these determinations based on the MAC's own data files.numberrequired : 1 level : Nominal
Freestanding_FacilityObtained from the Medicare provider number (A 3 in the third position of the provider number indicates a freestanding facility). Value of '1' indicates facility is a freestanding facility, value of '0' indicates facility is a distinct part unit of a hospital.numberlevel : Nominal
FY2016_Estimated_Average_Weight_Per_DischargeMeasure of the average value of the weight for each case in the FY 2015 analysis file using the CMGs and weights from the FY 2016 IRF PPS final rule. Short stay transfers are credited with only a fraction of the full CMG, with the fraction determined by the length of stay of the case..numberrequired : 1 level : Nominal
FY2016_Estimated_Outlier_PaymentFY 2016 simulated outlier payments, incorporating all of the policies outlined in the FY 2016 IRF PPS final ruleintegerrequired : 1 level : Nominal
FY2016_Estimated_Total_PPS_PaymentTotal FY 2016 simulated payments, including outlier payments, incorporating all of the policies outlined in the FY 2016 IRF PPS final rule..integerrequired : 1 level : Nominal
FY2017_Estimated_Average_Cost_Per_DischargeEstimated FY2017 average total cost per discharge based on FY 2015 Medicare claims data and using the cost-to-charge ratios from the March 2016 update of the Provider Specific File.integerrequired : 1 level : Nominal
FY2017_Estimated_Average_Weight_Per_DischargeMeasure of the average value of the weight for each case in the FY 2015 analysis file using the CMGs and weights from the FY 2017 final rule. Short stay transfers are credited with only a fraction of the full CMG, with the fraction determined by the length of stay of the case.numberrequired : 1 level : Nominal
FY2017_Estimated_PPS_Payment_Without_Including_Outlier_PayFY 2017 simulated payments, not including outlier payments, incorporating all of the policies outlined in the FY 2017 IRF PPS final rule.integerrequired : 1 level : Nominal
FY2017_Estimated_Outlier_PaymentFY 2017 simulated outlier payments, incorporating all of the policies outlined in the FY 2017 IRF PPS final rule.integerrequired : 1 level : Nominal
FY2017_Estimated_Total_PPS_PaymentTotal FY 2017 simulated payments, including outlier payments, incorporating all of the policies outlined in the FY 2017 IRF PPS final rule.integerrequired : 1 level : Nominal
FY2015_Actual_Total_PaymentTotal FY 2015 actual payments, including outlier payments, reported in the FY 2015 claims as submitted by March 30, 2016.integerrequired : 1 level : Nominal
Provider_IDNumber_of_DischargesCost_to_Charge_RatioWage_IndexIs_Facility_RuralDisproportionate_ShareCensus_RegionType_of_ControlTeaching_StatusFreestanding_FacilityFY2016_Estimated_Average_Weight_Per_DischargeFY2016_Estimated_Outlier_PaymentFY2016_Estimated_Total_PPS_PaymentFY2017_Estimated_Average_Cost_Per_DischargeFY2017_Estimated_Average_Weight_Per_DischargeFY2017_Estimated_PPS_Payment_Without_Including_Outlier_PayFY2017_Estimated_Outlier_PaymentFY2017_Estimated_Total_PPS_PaymentFY2015_Actual_Total_Payment
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