Outpatient Utilization and Payment Data 2013

$179 / year

The dataset includes estimated hospital-specific charges for select Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year 2013.

Complexity

The Outpatient Utilization and Payment Data Public Use File includes data on Medicare fee-for-service beneficiaries from Medicare Outpatient Prospective Payment System (OPPS) providers within 49 of the 50 United States and District of Columbia (excluding Maryland) with a known Hospital Referral Region (HRR) who are billing for select APCs. The utilization and spending data is aggregated to the following levels: a) the provider identifier, and b) Ambulatory Payment Classification (APC) Group. The provider identifier is the numeric CMS Certification Number (CCN) assigned to a Medicare certified facility. There can be multiple records for a given provider identifier based on the number of distinct APC codes that were billed. APCs are the main unit of payment under the OPPS. CMS assigns individual services (Healthcare Common Procedure Coding System [HCPCS] codes) to APCs based on similar clinical characteristics and
similar costs. The payment rate and copayment calculated for an APC apply to each service within the APC. For utilization, the number of outpatient services billed by the provider and used in the analysis for each APC is provided. In addition, the provider’s average total estimated submitted charges and average total payments within APC are also provided. Total payments consist of Medicare payments and beneficiary cost-share payments. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount. For these APCs, the estimated average charges and the average Medicare payments are provided at the individual hospital level. The actual charges at an individual hospital for an individual service within these APC groups may differ

Date Created

2016-06-23

Last Modified

2016-06-23

Version

2016-06-23

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

Outpatient Charges, Outpatient Payment Amount, Utilization And Payment Data, Outpatient Utilization Payments, Healthcare Utilization 2013, Outpatient Utilization, Medicare Utilization and Payment Data

Other Titles

Medicare Outpatient Utilization and Payment Data 2013, Medicare Outpatient Payment Charges Data 2013

NameDescriptionTypeConstraints
Ambulatory_Payment_Classification_CodesAmbulatory payment classification (APC) group, Code identifying the APC. APCs are a classification system where individual services (Healthcare Common Procedure Coding System [HCPCS] codes) are assigned based on similar clinical characteristics and similar costs.integerlevel : Nominal
Ambulatory_Payment_Classification_DescriptionAmbulatory payment classification (APC) group, description identifying the APC. APCs are a classification system where individual services (Healthcare Common Procedure Coding System [HCPCS] codes) are assigned based on similar clinical characteristics and similar costs.string-
Provider_IdProvider identification, The CMS Certification Number (CCN) of the provider billing for outpatient hospital services.integerlevel : Nominal
Provider_NameName of providerstring-
Provider_Street_AddressStreet address in which the provider is physically located.string-
CityThe city in which the provider is physically located.string-
State_AbbreviationThe state in which the provider is physically located.string-
Zip_CodeThe zip code in which the provider is physically locatedintegerlevel : Nominal
Hospital_Referral_RegionHosptial referral region in which the provider is physically located.string-
Outpatient_ServicesThe number of services billed by the provider for outpatient hospital services.numberlevel : Ratio
Average_Estimated_Submitted_ChargesThe provider's average estimated submitted charge for services covered by Medicare for the APC. These will vary from hospital to hospital because of differences in hospital charge structures.number-
Average_Total_PaymentsThe average of total payments to the provider for the APC including theMedicare APC amount. Also included in Total Payments are co-payment and deductible amounts that the patient is responsible for.number-
Ambulatory_Payment_Classification_CodesAmbulatory_Payment_Classification_DescriptionProvider_IdProvider_NameProvider_Street_AddressCityState_AbbreviationZip_CodeHospital_Referral_RegionOutpatient_ServicesAverage_Estimated_Submitted_ChargesAverage_Total_Payments
20Level II Excision/ Biopsy200020YORK HOSPITAL15 HOSPITAL DRIVEYORKME3909ME - Portland16870584.5875
20Level II Excision/ Biopsy360010UNION HOSPITAL659 BOULEVARDDOVEROH44622OH - Canton161038.025527.31
204Level I Nerve Injections390063UPMC HAMOT201 STATE STREETERIEPA16550PA - Erie151226.17153.5146667
206Level II Nerve Injections390063UPMC HAMOT201 STATE STREETERIEPA16550PA - Erie161696.08125259.4425
368Level II Pulmonary Tests100142JACKSON HOSPITAL4250 HOSPITAL DRMARIANNAFL32446AL - Dothan5222659.01
377Level II Cardiac Imaging100048JAY HOSPITAL14114 ALABAMA STJAYFL32565FL - Pensacola254728.72577.1272
368Level II Pulmonary Tests360010UNION HOSPITAL659 BOULEVARDDOVEROH44622OH - Canton219143.953196356.84
368Level II Pulmonary Tests100053HIALEAH HOSPITAL651 E 25TH STHIALEAHFL33013FL - Miami28426.128571462.7
368Level II Pulmonary Tests520089MERITER HOSPITAL202 S PARK STMADISONWI53715WI - Madison50339.1865.5724
204Level I Nerve Injections70029BRISTOL HOSPITALBREWSTER RDBRISTOLCT6010CT - Hartford162056.598125193.25