Medicare HHRG Aggregate Table By State 2013

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

Complexity

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.

Date Created

2015-12-09

Last Modified

2017-10-12

Version

2017-10-12

Update Frequency

Annual

Temporal Coverage

2013

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services

Source License URL

John Snow Labs Standard License

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 State 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

NameDescriptionTypeConstraints
Home_Health_Resource_Group_CategoryHome health resource group 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
StateName of Statestring-
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 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
Average_HHA_Medicare_Standard_Payment_AmountAverage amount that Medicare paid for non-LUPA episodes adjusted for geographic differences in payment ratesintegerlevel : Ratio
Home_Health_Resource_Group_CategoryEpisode_TypeTherapiesClinical_Severity_LevelFunctional_Severity_LevelService_Severity_LevelStateTotal_EpisodesDistinct_UsersAverage_HHA_Charge_AmountAverage_HHA_Medicare_Payment_AmountAverage_HHA_Medicare_Standard_Payment_Amount
3AFKLate Episode0-13111PR412815828161473
3BFKLate Episode0-13211PR463121849521676
1AFKEarly Episode0-13111PR969116219381731
3AFKLate Episode0-13111AK2315193118211488
3AFKLate Episode0-13111DC3827212620231706
3AFKLate Episode0-13111DE6550180015011451
3AFKLate Episode0-13111ME5854158613711440
3AFKLate Episode0-13111MT3626242418521756
3AFKLate Episode0-13111ND4525222913041536
3AFKLate Episode0-13111SD4227163512371392