The historical claims data is used to rebase the Medicare Advantage (MA) Fee-For-Service (FFS) capitation rate book for the years that follow. The historical claims data is rebased to reflect the most current wage and cost indices, repriced the claims to account for the changes made by the Affordable Care Act (ACA) to payments to disproportionate share hospitals, and also repriced durable medical equipment claims to account for the change in prices associated with the competitive bid program. The adjusted or repriced datasets for aged and disabled reflect the annual impact of the repricing of FFS claims. The institutional claims – acute inpatient hospital, skilled nursing facility, hospital outpatient, home health agency, and physician – reflect the repricing of the original claims with the current geographic practice cost index (GPCI).
Adjustments have also been made to reflect the transition of disproportionate share hospital (DSH) payments to uncompensated care payments (UCP). The effects of competitive bidding for durable medical equipment (DME) are reflected in the corresponding adjustment dataset. An additional adjustment to the 2012-2016 claims to account for shared savings payments and shared losses is made to Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO), including ACOs from Pioneer program for 2012 and without the ACOs of Pioneer program for 2013-2016. The dataset contains information on ACOs combined data for aged and disabled beneficiaries reimbursement for part A and part B by state and county of residence.
Data cells with less than 11 beneficiaries have been suppressed for privacy.