Inpatient Utilization and Payment Data 2016

$447.50 / year

The dataset provided here include hospital-specific charges for the U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2016. These MS-DRGs represent more than 7 million discharges or 75 percent of total Medicare IPPS discharges.

Complexity

The Inpatient Utilization and Payment Public Use File (Inpatient PUF) provides information on inpatient discharges for Medicare fee-for-service beneficiaries. The Inpatient PUF includes information on utilization, payment (total payment and Medicare payment), and hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments. The PUF is organized by hospital and Medicare Severity Diagnosis Related Group (MS-DRG) and covers Fiscal Year (FY) 2016.

Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service. The Total Payment amount includes the MS-DRG amount, bill total per diem, beneficiary primary payer claim payment amount, beneficiary Part A coinsurance amount, beneficiary deductible amount, beneficiary blood deducible amount and DRG outlier amount.

Date Created

2015-01-01

Last Modified

2018-08-15

Version

2018-08-15

Update Frequency

Annual

Temporal Coverage

2016-01 to 2016-12

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare & Medicaid Services (CMS);

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Inpatient Utilization Payment, Medicare Reimbursement, Medicare Payment List, Inpatient CMS Medicare Prospective Payment, Inpatient Data, DRG Charges, Medicare Payment, Inpatient Payment Data

Other Titles

Inpatient CMS Medicare Prospective Payment System Top 100 Diagnosis Related Group 2016, Medicare Reimbursement for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2016, Medicare List for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2016, CMS Report for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2016

NameDescriptionTypeConstraints
DRG_CodeThe code identifying the MS-DRG. MS-DRGs are a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay.string-
DRG_DefinitionThe code and description identifying the MS-DRG. MS-DRGs are a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay.string-
Provider_IdThe CMS Certification Number (CCN) assigned to the Medicare certified hospital facility.integerlevel : Nominal
Provider_NameThe name of the provider.string-
Provider_Street_AddressThe provider’s street address.string-
CityThe city where the provider is located.string-
State_AbbreviationThe state where the provider is located.string-
Zip_CodeThe provider’s zip code.integerlevel : Nominal
Provider_HRRThe Hospital Referral Region (HRR) where the provider is located.string-
Total_DischargesThe number of discharges billed by the provider for inpatient hospital services.integerlevel : Interval
Average_Covered_ChargesThe provider's average charge for services covered by Medicare for all discharges in the MS-DRG. These will vary from hospital to hospital because of differences in hospital charge structures.number-
Average_Total_PaymentsThe average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.number-
Average_Medicare_PaymentsThe average amount that Medicare pays to the provider for Medicare's share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits. Note: In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, incurred a 2 percent reduction in Medicare payment. This is in response to mandatory across-the board reductions in Federal spending, also known as sequestration.number-
DRG CodeDRG DefinitionProvider IdProvider NameProvider Street AddressCityState AbbreviationZip CodeProvider HRRTotal DischargesAverage Covered ChargesAverage Total PaymentsAverage Medicare Payments
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC100007FLORIDA HOSPITAL601 E ROLLINS STORLANDOFL32803FL - Orlando361126268.58189464.0182770.86
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC100022JACKSON MEMORIAL HOSPITAL1611 NW 12TH AVEMIAMIFL33136FL - Miami151050063.13301640.47252782.53
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC100113UF HEALTH SHANDS HOSPITAL1600 SW ARCHER RDGAINESVILLEFL32610FL - Gainesville15569379.33211545.13199879.2
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC100128TAMPA GENERAL HOSPITAL1 TAMPA GENERAL CIRTAMPAFL33606FL - Tampa241058968.75198471.08189331.79
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC100151MAYO CLINIC4500 SAN PABLO RDJACKSONVILLEFL32224FL - Jacksonville20802446.9321528.1188267.9
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC110010EMORY UNIVERSITY HOSPITAL1364 CLIFTON ROAD, NEATLANTAGA30322GA - Atlanta21570772.67230594.62199397.95
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC110083PIEDMONT HOSPITAL1968 PEACHTREE RD NWATLANTAGA30309GA - Atlanta21777330.14180425.38175385.33
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC140088THE UNIVERSITY OF CHICAGO MEDICAL CENTER5841 SOUTH MARYLANDCHICAGOIL60637IL - Chicago381113213.79260996.68245171.84
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC140208ADVOCATE CHRIST HOSPITAL & MEDICAL CENTER4440 W 95TH STREETOAK LAWNIL60453IL - Blue Island42873338.4256448.88209552.57
1 HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM W MCC140276LOYOLA UNIVERSITY MEDICAL CENTER2160 S 1ST AVENUEMAYWOODIL60153IL - Melrose Park21619413.33229529.1217176.33