Repricing FFS Claims Aged Disabled Outpatient Healthcare Services

$179 / year

The dataset includes the data for aged and disabled, Medicare Part B, beneficiaries reimbursement for outpatient healthcare services by state and county of residence. The data included cover the years 2010 to 2016.

Complexity

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 Organizations (ACO), including ACOs from Pioneer program for 2012 and without the ACOs of Pioneer program for 2013-2016. 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.

Date Created

2016-04-04

Last Modified

2018-02-01

Version

2018-02-01

Update Frequency

Annual

Temporal Coverage

2010-2016

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

Aged Beneficiaries Reimbursement, Disabled Beneficiaries Reimbursement, Outpatient Reimbursement, Medicare Fee for Service Data, Part B Cost Contracts, Medicare Fee-for-Service Reimbursement, Medicare Advantage Fee-For-Service, ACO Part B Reimbursement, Medicare Spending per Beneficiary, Aged Outpatient Healthcare Services, Disabled Outpatient Healthcare Services

Other Titles

Aged Disabled Beneficiaries Reimbursement For Outpatient Healthcare Services, Aged Disabled Beneficiaries Medicare Fee-For-Service Data By County, Repricing Of FFS Claims Aged Disabled Outpatient Healthcare Services By County

NameDescriptionTypeConstraints
Beneficiaries_TypeSpecifies if the beneficiaries data are for Aged or Disabled or combined data for Aged and Disabledstring-
FIPS_CodeThe 5 digits county Federal Information Processing Standard (FIPS) codestring-
State_AbbreviationThe abbreviated name of the statestring-
StateThe full name of the statestring-
CountyThe name of the countystring-
Year_2010Repricing adjustments to the Part B 2010 reimbursement data for outpatient fee-for-service; only separate data for aged and for disabledintegerlevel : Ratio
Year_2011Repricing adjustments to the Part B 2011 reimbursement data for outpatient fee-for-serviceintegerlevel : Ratio
Year_2012Repricing adjustments to the Part B 2012 reimbursement data for outpatient fee-for-serviceintegerlevel : Ratio
Year_2013Repricing adjustments to the Part B 2013 reimbursement data for outpatient fee-for-serviceintegerlevel : Ratio
Year_2014Repricing adjustments to the Part B 2014 reimbursement data for outpatient fee-for-serviceintegerlevel : Ratio
Year_2015Repricing adjustments to the Part B 2015 reimbursement data for outpatient fee-for-service; only combined data for aged and for disabled (starting 2015)integerlevel : Ratio
Year_2016Repricing adjustments to the Part B 2016 reimbursement data for outpatient fee-for-service; only combined data for aged and for disabled (starting 2015)integerlevel : Ratio
Beneficiaries_TypeFIPS_CodeState_AbbreviationStateCountyYear_2010Year_2011Year_2012Year_2013Year_2014Year_2015Year_2016
AgedGUGuamGuam
DisabledGUGuamGuam
Disabled46160UTUtahRich
Disabled45741TXTexasKing
Disabled13120IDIdahoCamas
Disabled13160IDIdahoClark
Disabled12040HIHawaiiKauai
Disabled45150TXTexasBorden
Disabled45732TXTexasKenedy
Disabled45762TXTexasLoving