Repricing FFS Claims Aged Disabled Puerto Rico PartA And PartB

$179 / year

The dataset includes the data for aged and disabled, Medicare Part A and Part B, beneficiaries reimbursement for Puerto Rico by county of residence. The data included cover the years 2014 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 are 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. 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.

Date Created

2016-04-04

Last Modified

2018-02-01

Version

2018-02-01

Update Frequency

Annual

Temporal Coverage

2014-2016

Spatial Coverage

Puerto Rico

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, Puerto Rico Reimbursement, Medicare Fee for Service Data, Part A and Part B Cost Contracts, Medicare Fee-for-Service Reimbursement, Medicare Advantage Fee-For-Service, ACO Part A and Part B Reimbursement, Medicare Spending Per Beneficiary, Aged Puerto Rico, Disabled Puerto Rico

Other Titles

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

NameDescriptionTypeConstraints
YearThe year of the corresponding datadate-
Beneficiaries_TypeSpecifies if the beneficiaries data are for combined data for aged and disabled (combined) or aged or disabled; starting with 2015 available data the values for aged and disabled beneficiaries have been combinedstringenum : Array
FIPS_CodeThe 5 digits county Federal Information Processing Standard (FIPS) codestring-
CountyName of countystring-
Part_A_Total_EnrollmentThe total number of Medicare Part A aged and disabled (combined) or aged or disabled Puerto Rico enrolleesintegerlevel : Ratio
Part_A_Total_ReimbursementRepricing adjustments to the Part A reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees fee-for-service costsintegerlevel : Ratio
Part_A_Total_Per_CapitaRepricing adjustments to the Part A reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees costs, per Medicare Part A aged and disabled (combined) or aged or disabled Puerto Rico enrolleenumberlevel : Ratio
Part_A_Total_Reimbursement_Without_IME_DSH_DGMERepricing adjustments to the Part A reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees fee-for-service costs, without direct graduate medical education (DGME) and indirect medical education (IME) expenditures and disproportionate share hospital (DSH) expendituresintegerlevel : Ratio
Part_A_Total_Per_Capita_Without_IME_DSH_DGMERepricing adjustments to the Part A reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees fee-for-service costs, without DGME, IME and DSH costs, per Medicare Part A aged and disabled (combined) or aged or disabled Puerto Rico enrolleenumberlevel : Ratio
Part_A_Reimbursement_For_IMEMedicare fee-for-service Part A reimbursement for indirect medical education (IME) expendituresintegerlevel : Ratio
Part_A_Reimbursement_For_DSHMedicare fee-for-service Part A reimbursement for disproportionate share hospital (DSH) expendituresintegerlevel : Ratio
Part_A_Reimbursement_For_DGMEMedicare fee-for-service Part A reimbursement for direct graduate medical education (DGME) expendituresintegerlevel : Ratio
Part_B_Total_EnrollmentThe total number of Medicare Part B aged and disabled (combined) or aged or disabled Puerto Rico enrolleesintegerlevel : Ratio
Part_B_Total_ReimbursementRepricing adjustments to the Part B reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees fee-for-service costsintegerlevel : Ratio
Part_B_Total_Per_CapitaRepricing adjustments to the Part B reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees costs, per Medicare Part B aged and disabled (combined) or aged or disabled Puerto Rico enrolleenumberlevel : Ratio
Combined_Aged_Disabled_Average_Risk_ScoreThe average CMS Hierarchical Condition Categories (HCC) risk score for the aged and disabled (combined) Puerto Rico enrolleesnumberlevel : Ratio
YearBeneficiaries_TypeFIPS_CodeCountyPart_A_Total_EnrollmentPart_A_Total_ReimbursementPart_A_Total_Per_CapitaPart_A_Total_Reimbursement_Without_IME_DSH_DGMEPart_A_Total_Per_Capita_Without_IME_DSH_DGMEPart_A_Reimbursement_For_IMEPart_A_Reimbursement_For_DSHPart_A_Reimbursement_For_DGMEPart_B_Total_EnrollmentPart_B_Total_ReimbursementPart_B_Total_Per_CapitaCombined_Aged_Disabled_Average_Risk_Score
2014Aged40265Florida
2014Aged40145Canovanas
2014Disabled40240Culebra
2014Disabled40265Florida
2014Disabled40145Canovanas
2014Disabled40440Luquillo32
2016Aged and disabled40265Florida
2016Aged and disabled40145Canovanas
2015Aged and disabled40145Canovanas72
2015Aged and disabled40265Florida1031.39