Others titles

  • Medicare Outpatient Utilization and Payment Data 2018
  • Medicare Outpatient Payment Charges Data 2018

Keywords

  • Outpatient Charges
  • Outpatient Payment Amount
  • Utilization and Payment Data
  • Outpatient Utilization Payments
  • Healthcare Utilization 2018
  • Outpatient Utilization
  • Medicare Utilization and Payment Data

Outpatient Utilization and Payment Data 2018

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 2018.

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Description

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.

About this Dataset

Data Info

Date Created

2016-06-23

Last Modified

2020-04-21

Version

2020-04-21

Update Frequency

Annual

Temporal Coverage

2018

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 2018, Outpatient Utilization, Medicare Utilization and Payment Data

Other Titles

Medicare Outpatient Utilization and Payment Data 2018, Medicare Outpatient Payment Charges Data 2018

Data Fields

Name Description Type Constraints
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-
Provider_State_FIPS_CodeThe Federal Information Processing Standard (FIPS) code for the state in which the provider is physically located.string-
Zip_CodeThe zip code in which the provider is physically locatedintegerlevel : Nominal
Provider_RUCA_CodeThe Rural-Urban Commuting Area (RUCA) code for the zip code in which the provider is physically located.numberlevel : Nominal
Provider_RUCA_DescriptionThe description of the RUCA code.string-
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-
Total_BeneficiariesThe number of Medicare fee-for-service beneficiaries receiving outpatient hospital services.integerlevel : Ratio
CAPC_ServicesThe number of primary HCPCS services billed by the provider for outpatient hospital services.integerlevel : Ratio
Average_Total_Submitted_ChargesThe provider's average estimated submitted charge for services covered by Medicare for the APC.numberlevel : Ratio
Average_Medicare_Allowed_AmountThe average of total regular payments the provider receives for the APC.numberlevel : Ratio
Average_Medicare_Payment_AmountThe average of total regular payments the provider receives directly from Medicare.numberlevel : Ratio
Outlier_ServicesThe number of comprehensive APC services with outlier payments.integerlevel : Ratio
Average_Medicare_Outlier_AmountThe average of outlier payments the provider receives directly from Medicare.numberlevel : Ratio

Data Preview

Provider IdProvider NameProvider Street AddressCityState AbbreviationProvider State FIPS CodeZip CodeProvider RUCA CodeProvider RUCA DescriptionAmbulatory Payment Classification CodesAmbulatory Payment Classification DescriptionTotal BeneficiariesCAPC ServicesAverage Total Submitted ChargesAverage Medicare Allowed AmountAverage Medicare Payment AmountOutlier ServicesAverage Medicare Outlier Amount
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5072Level 2 Excision/ Biopsy/ Incision and Drainage24826210383.751140.88908.56
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5073Level 3 Excision/ Biopsy/ Incision and Drainage313517145.81937.481535.27
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5091Level 1 Breast/Lymphatic Surgery and Related Procedures232311134.422321.831849.91
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5092Level 2 Breast/Lymphatic Surgery and Related Procedures444416885.494095.683263.22
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5112Level 2 Musculoskeletal Procedures202011335.051103.25869.71
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5113Level 3 Musculoskeletal Procedures616212704.462251.561791.58
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5114Level 4 Musculoskeletal Procedures13413922364.924744.613774.7
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5115Level 5 Musculoskeletal Procedures404031607.748608.07268.0
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5153Level 3 Airway Endoscopy31318618.171126.68897.68
10001Southeast Alabama Medical Center1108 Ross Clark CircleDothanAL1363011Metropolitan area core: primary flow within an urbanized area of 50,000 and greater5154Level 4 Airway Endoscopy606110999.812227.121774.45