Others 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
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
Repricing FFS Claims Aged Disabled Puerto Rico PartA And PartB

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 year 2022.
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Description
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 2013-2018. 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.
About this Dataset
Data Info
Date Created | 2016-04-04 |
---|---|
Last Modified | 2022-01-13 |
Version | 2022-01-13 |
Update Frequency |
Annual |
Temporal Coverage |
2022 |
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 |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
FIPS_Code | The 5 digits county Federal Information Processing Standard (FIPS) code | string | - |
State | State name | string | - |
County | Name of county | string | - |
Part_A_Total_Enrollment | The total number of Medicare Part A aged and disabled (combined) or aged or disabled Puerto Rico enrollees | integer | level : Ratio |
Part_A_Total_Reimbursement | Repricing adjustments to the Part A reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees fee-for-service costs | integer | level : Ratio |
Part_A_Total_Per_Capita | Repricing 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 enrollee | number | level : Ratio |
Part_A_Total_Reimbursement_Without_IME_DSH_DGME | Repricing 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) expenditures | integer | level : Ratio |
Part_A_Total_Per_Capita_Without_IME_DSH_DGME | Repricing 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 enrollee | number | level : Ratio |
Part_A_Reimbursement_For_IME | Medicare fee-for-service Part A reimbursement for indirect medical education (IME) expenditures | integer | level : Ratio |
Part_A_Reimbursement_For_DSH | Medicare fee-for-service Part A reimbursement for disproportionate share hospital (DSH) expenditures | integer | level : Ratio |
Part_A_Reimbursement_For_DGME | Medicare fee-for-service Part A reimbursement for direct graduate medical education (DGME) expenditures | integer | level : Ratio |
Part_B_Total_Enrollment | The total number of Medicare Part B aged and disabled (combined) or aged or disabled Puerto Rico enrollees | integer | level : Ratio |
Part_B_Total_Reimbursement | Repricing adjustments to the Part B reimbursement data for aged and disabled (combined) or aged or disabled Puerto Rico enrollees fee-for-service costs | integer | level : Ratio |
Part_B_Total_Per_Capita | Repricing 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 enrollee | number | level : Ratio |
Data Preview
FIPS Code | State | County | Part A Total Enrollment | Part A Total Reimbursement | Part A Total Per Capita | Part A Total Reimbursement Without IME DSH DGME | Part A Total Per Capita Without IME DSH DGME | Part A Reimbursement For IME | Part A Reimbursement For DSH | Part A Reimbursement For DGME | Part B Total Enrollment | Part B Total Reimbursement | Part B Total Per Capita |
40010 | PUERTO RICO | ADJUNTAS | 1009 | 1763827 | 145.67 | 1491369 | 123.17 | 76103 | 30938 | 165417 | 115 | 296989 | 215.21 |
40020 | PUERTO RICO | AGUADA | 1887 | 2438888 | 107.71 | 2278415 | 100.62 | 67047 | 44692 | 48734 | 361 | 731321 | 168.82 |
40030 | PUERTO RICO | AGUADILLA | 3305 | 3823495 | 96.41 | 3527112 | 88.93 | 115504 | 69926 | 110953 | 865 | 2095215 | 201.85 |
40040 | PUERTO RICO | AGUAS BUENAS | 1216 | 1729122 | 118.5 | 1691756 | 115.94 | 1173 | 33449 | 2744 | 171 | 284043 | 138.42 |
40050 | PUERTO RICO | AIBONITO | 1462 | 1904379 | 108.55 | 1834609 | 104.57 | 13031 | 50000 | 6739 | 336 | 626832 | 155.46 |
40060 | PUERTO RICO | ANASCO | 1084 | 1408228 | 108.26 | 1269402 | 97.59 | 55840 | 20405 | 62581 | 187 | 495315 | 220.73 |
40070 | PUERTO RICO | ARECIBO | 5550 | 7764502 | 116.58 | 7373694 | 110.72 | 157406 | 159440 | 73962 | 1179 | 2785855 | 196.91 |
40080 | PUERTO RICO | ARROYO | 841 | 1198585 | 118.77 | 1139026 | 112.86 | 23071 | 24969 | 11519 | 132 | 225590 | 142.42 |
40090 | PUERTO RICO | BARCELONETA | 1841 | 2690999 | 121.81 | 2566065 | 116.15 | 40819 | 62537 | 21578 | 375 | 819414 | 182.09 |
40100 | PUERTO RICO | BARRANQUITAS | 1432 | 2234073 | 130.01 | 2144196 | 124.78 | 16652 | 54264 | 18961 | 198 | 437540 | 184.15 |