Others titles

  • Medicare HHRG Aggregate Table Payment National Data 2013
  • Medicare Standardized Payment HHRG Aggregate Table 2013
  • Medicare HHRG Aggregate Table Utilization and Payment Data 2013
  • Medicare Home Health Resource Group Cost Data 2013

Keywords

  • Medicare Payments
  • HHA Submitted Charges
  • Medicare Rate
  • Medicare Home
  • Medicare
  • Home Health Agency
  • Utilization and Payment Data

Medicare HHRG Aggregate Table 2013

The dataset “HHRG Aggregate Table” contains information on utilization, Medicare payment, and submitted charges organized by HHRG.

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Description

The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standardized payment), and submitted charges organized by Centers for Medicare and Medicaid Services (CMS) Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Home Health Agency PUF covers calendar year 2013 and contains 100% final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.

The spending and utilization data in the Home Health Agency PUF are aggregated to the following:
a) the identification number for the agency, and
b) the Home Health Resource Group (HHRG).

Medicare makes payment under the home health prospective payment system on the basis of a national standardized 60-day episode payment rate that is adjusted for the applicable case-mix and wage index. The national standardized 60-day episode rate includes the six home health disciplines (skilled nursing, home health aide, physical therapy, speech-language pathology, occupational therapy, and medical social services). To adjust for case-mix, patients are assigned to one of 153 home health resource groups (HHRG). The clinical severity level, functional severity level, and service utilization are used to place the patient in a particular HHRG. Each HHRG has an associated case-mix weight which is used in calculating the payment for an episode. For episodes with four or fewer visits, Medicare pays national per-visit rates based on the discipline(s) providing the services. An episode consisting of four or fewer visits within a 60-day period receives what is referred to as a low utilization payment adjustment (LUPA). For certain cases that exceed a specific cost threshold, an outlier adjustment may also be available.

About this Dataset

Data Info

Date Created

2015-12-09

Last Modified

2017-10-31

Version

2017-10-31

Update Frequency

Annual

Temporal Coverage

2013

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare Payments, HHA Submitted Charges, Medicare Rate, Medicare Home, Medicare, Home Health Agency, Utilization and Payment Data

Other Titles

Medicare HHRG Aggregate Table Payment National Data 2013, Medicare Standardized Payment HHRG Aggregate Table 2013, Medicare HHRG Aggregate Table Utilization and Payment Data 2013, Medicare Home Health Resource Group Cost Data 2013

Data Fields

Name Description Type Constraints
Home_Health_Resource_Group_CategoryHHRG category codestring-
Episode_TypeDescription of the HHRG categorystring-
TherapiesNumber of therapies receivedstring-
Clinical_Severity_LevelSeverity of the illness. Clinical severity is a Measure of disability of 3 levels, 3 being most severeintegerlevel : Ratio
Functional_Severity_LevelSeverity of physical function. Functional severity is a Measure of disability of 3 levels, 3 being most severeintegerlevel : Ratio
Service_Severity_Levelintegerlevel : Ratio
Total_EpisodesTotal count of episodes provided by a specific home health agency or in a unique HHRG category in the calendar yearintegerlevel : Ratio
Distinct_UsersNumber of distinct Medicare beneficiaries receiving at least one of home health episode in the calendar year. Beneficiaries may receive multiple home health episodes per year but are only counted once in this field.integerlevel : Ratio
Average_HHA_Charge_AmountAverage of the charges that the home health agency submitted for non-LUPA episodes.integerlevel : Ratio
Average_HHA_Medicare_Payment_AmountAverage amount that Medicare paid for non-LUPA episodes. Home health services do not have any cost-sharing requirements and the Medicare payment amount will equal the allowed amount.integerlevel : Ratio

Data Preview

Home Health Resource Group CategoryEpisode TypeTherapiesClinical Severity LevelFunctional Severity LevelService Severity LevelTotal EpisodesDistinct UsersAverage HHA Charge AmountAverage HHA Medicare Payment Amount
1AFKEarly Episode0-131111005589466416171720
1AFLEarly Episode0-13112134551341717972046
1AFMEarly Episode0-13113334153309222322371
1AFNEarly Episode0-131148035801526262694
1AFPEarly Episode0-13115200981989129693003
1AGKEarly Episode0-1312119155918236317012151
1AGLEarly Episode0-13122464524620219452457
1AGMEarly Episode0-1312313287713087423532736
1AGNEarly Episode0-13124368063661427753001
1AGPEarly Episode0-13125995919782931723263