Others titles
- Medicare Home Healthcare Outpatient Prospective Payment System 2013
- Medicare Suffix for OPPS Provider Summary 2013
- Medicare Doctors Provider Summary for OPPS 2013
Keywords
- Outpatient Prospective Payment System
- Ambulatory Payment Classification Groups
- Medicare Hospital
- Hospital Service Areas (HSAs)
Provider Summary of Outpatient Prospective Payment System APC 2013
This dataset contains estimated hospital specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2013. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
Get The Data
- ResearchNon-Commercial, Share-Alike, Attribution Free Forever
- CommercialCommercial Use, Remix & Adapt, White Label Log in to download
Description
In response to the rapidly growing Medicare expenditures for outpatient services and large co-payments being made by Medicare beneficiaries, Congress mandated that the Centers for Medicare and Medicaid Services (CMS) develop a Hospital Outpatient Prospective Payment System (HOPPS) and reduce beneficiary co-payments. This payment system, implemented August 1, 2000, is used by CMS to reimburse for hospital outpatient services.
The hospital outpatient prospective payment system (OPPS) in place today classifies all hospital outpatient services into Ambulatory Payment Classifications (APCs). Ambulatory Payment Classifications (APCs) are CMS’ grouping system developed for facility reimbursement for hospital outpatient services. All covered outpatient services to an APC group. Each group of procedure (i.e.,codes) within an APC is supposed to be “similar clinically and with regard to resource consumption.” Healthcare Common Procedure Coding System codes (HCPCS codes) are assigned to APCs by CMS, and these assignments are updated at least annually (HCPCS code sets include the full Current Procedural Terminology code set).
The services assigned to any APC are considered by CMS to be clinically similar and similar in terms of the resources required to provide each service. Thus, one APC may be applied to numerous HCPCS codes, whereas any individual HCPCS code can be assigned to only one APC. Notably, many HCPCS codes are not assigned to any APC. Some are considered “packaged” into some other code, some are identified as appropriate only for the inpatient setting, and some are simply not considered by CMS to be payable under the OPPS. Thus, one must actually refer to the CMS files listing all HCPCS codes in order to determine whether the service is paid.
About this Dataset
Data Info
Date Created | 2013-05-01 |
---|---|
Last Modified | 2017-03-30 |
Version | 2017-03-30 |
Update Frequency |
Annual |
Temporal Coverage |
N/A |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare & Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Outpatient Prospective Payment System, Ambulatory Payment Classification Groups, Medicare Hospital, Hospital Service Areas (HSAs) |
Other Titles | Medicare Home Healthcare Outpatient Prospective Payment System 2013, Medicare Suffix for OPPS Provider Summary 2013, Medicare Doctors Provider Summary for OPPS 2013 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Ambulatory_Payment_Classification_Number | APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. It represents the numeric part of the APC group code. | string | - |
Ambulatory_Payment_Classification_Group | APCs or Ambulatory Payment Classifications are the United States government's method of paying for facility outpatient services for the Medicare (United States) program. It represents the specific group for the APC. | string | required : 1 |
Provider_Id | Centers for Medicare & Medicaid Services (CMS) certification number (CCN). Identification number of the facility within the CMS dataset. The CCN for providers and suppliers is a 6 digit number. The first 2 digits identify the State in which the provider is located.The last 4 digits identify the type of facility. | integer | level : Nominalrequired : 1 |
Provider_Name | Name of the hospital (also referred to as the provider) | string | required : 1 |
Provider_Street_Address | Main street address information of the hospital | string | required : 1 |
Provider_City | Mailing city. The city in the main street address of the hospital. | string | required : 1 |
State_Abbreviation | Two-letter state abbreviation in the mailing address of the hospital. This includes information on hospitals in: | string | required : 1 |
Zip_Code | 5 digit postal zip code in the mailing address of the hospital. | integer | level : Nominalrequired : 1 |
Provider_Hospital_Referral_Region_Description | Describes the hospital referral region of the provider. | string | required : 1 |
Outpatient_Services | The number of outpatient services provided. | integer | level : Intervalrequired : 1 |
Average_Estimated_Submitted_Charges_In_Dollars | Indicates the average estimated charges in US Dollars submitted to Medicare by a facility or provider. | number | level : Ratiorequired : 1 |
Average_Total_Payments_In_Dollars | Indicates the average estimated total payments in US Dollars. | number | level : Ratiorequired : 1 |
Data Preview
Ambulatory Payment Classification Number | Ambulatory Payment Classification Group | Provider Id | Provider Name | Provider Street Address | Provider City | State Abbreviation | Zip Code | Provider Hospital Referral Region Description | Outpatient Services | Average Estimated Submitted Charges In Dollars | Average Total Payments In Dollars |
13 | Level II Debridement & Destruction | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 639 | 391.64 | 54.94 |
15 | Level III Debridement & Destruction | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 503 | 595.82 | 83.51 |
19 | Level I Excision/ Biopsy | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 23 | 3531.88 | 254.15 |
20 | Level II Excision/ Biopsy | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 32 | 4596.94 | 507.3 |
78 | Level III Pulmonary Treatment | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 142 | 218.82 | 87.6 |
96 | Level II Noninvasive Physiologic Studies | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 363 | 988.04 | 93.59 |
204 | Level I Nerve Injections | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 385 | 2084.46 | 147.57 |
206 | Level II Nerve Injections | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 67 | 1438.85 | 240.75 |
207 | Level III Nerve Injections | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 3169 | 2228.79 | 480.49 |
209 | Level II Extended EEG, Sleep, and Cardiovascular Studies | 10001 | SOUTHEAST ALABAMA MEDICAL CENTER | 1108 ROSS CLARK CIRCLE | DOTHAN | AL | 36301 | AL - Dothan | 729 | 4468.12 | 697.15 |