Others titles
- Inpatient CMS Medicare Prospective Payment System Top 100 Diagnosis Related Group 2020
- Medicare Reimbursement for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2020
- Medicare List for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2020
- CMS Report for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2020
Keywords
- Inpatient Utilization Payment
- Medicare Reimbursement
- Medicare Payment List
- Inpatient CMS Medicare Prospective Payment
- Inpatient Data
- DRG Charges
- Medicare Payment
- Inpatient Payment Data
Inpatient Utilization and Payment Data 2020

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) 2020. These MS-DRGs represent more than 7 million discharges or 75 percent of total Medicare IPPS discharges.
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Description
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) 2017.
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.
About this Dataset
Data Info
Date Created | 2022-07-20 |
---|---|
Last Modified | 2022-07-27 |
Version | 2022-07-27 |
Update Frequency |
Annual |
Temporal Coverage |
2020-01 to 2020-12 |
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 2020, Medicare Reimbursement for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2020, Medicare List for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2020, CMS Report for Inpatient Prospective Payment System Top 100 Diagnosis Related Group 2020 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Provider_Id | The CMS Certification Number (CCN) assigned to the Medicare certified hospital facility. | integer | level : Nominal |
Provider_Name | The name of the provider. | string | - |
Provider_Street_Address | The provider’s street address. | string | - |
City | The city where the provider is located. | string | - |
State_Abbreviation | The state where the provider is located. | string | - |
Provider_State_FIPS_Code | The Federal Information Processing Standard (FIPS) code for the state in which the provider is physically located. | string | - |
Zip_Code | The provider’s zip code. | integer | level : Nominal |
Provider_RUCA_Code | The Rural-Urban Commuting Area (RUCA) code for the zip code in which the provider is physically located. | number | level : Nominal |
Provider_RUCA_Description | The description of the RUCA code. | string | - |
DRG_Code | The 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_Definition | The 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 | - |
Total_Discharges | The number of discharges billed by the provider for inpatient hospital services. | integer | level : Ratio |
Average_Covered_Charges | The 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_Payments | The 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_Payments | The 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 | - |
Data Preview
Provider Id | Provider Name | Provider Street Address | City | State Abbreviation | Provider State FIPS Code | Zip Code | Provider RUCA Code | Provider RUCA Description | DRG Code | DRG Definition | Total Discharges | Average Covered Charges | Average Total Payments | Average Medicare Payments |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 23 | CRANIOTOMY W MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PDX W MCC OR | 51 | 166625.86 | 37033.31 | 33908.45 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 24 | CRANIOTOMY WITH MAJOR DEVICE IMPLANT OR ACUTE COMPLEX CNS PRINCIPAL | 16 | 105888.13 | 26208.69 | 22531.25 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 25 | CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W MCC | 30 | 182686.37 | 29491.53 | 27775.5 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 27 | CRANIOTOMY & ENDOVASCULAR INTRACRANIAL PROCEDURES W/O CC/MCC | 11 | 117292.91 | 15641.0 | 14357.18 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 38 | EXTRACRANIAL PROCEDURES WITH CC | 25 | 112528.68 | 11398.56 | 9559.28 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 39 | EXTRACRANIAL PROCEDURES W/O CC/MCC | 50 | 83801.46 | 7799.86 | 6433.16 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 56 | DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC | 14 | 54607.21 | 14032.86 | 12117.14 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 57 | DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC | 23 | 19446.78 | 8117.78 | 6760.83 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 64 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC | 101 | 57110.22 | 13254.3 | 11000.65 |
10001 | Southeast Health Medical Center | 1108 Ross Clark Circle | Dothan | AL | 1 | 36301 | 1 | Metropolitan area core: primary flow within an urbanized area of 50,000 and greater | 65 | INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 | 99 | 26766.96 | 7269.17 | 5532.14 |