Repricing FFS Claims Aged Skilled Nursing Facility Reimbursement

$179 / year

The dataset includes data for Aged beneficiaries of Skilled Nursing Facility Reimbursement by state and county of residence. Medicare fee-for-service data for each county broken down by aged, disabled, and end-stage renal disease (ESRD) beneficiaries.

Complexity

The historical claims data for 2010 through 2014 is used to rebase the Medicare Advantage (MA) Fee-For-Service (FFS) capitation rate book for 2017. 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. Medicare fee-for-service data for each county broken down by aged, disabled, and end-stage renal disease (ESRD) beneficiaries including data on total Medicare Fee-For-Service (FFS) reimbursement and enrollment for Parts A and B, the corresponding per capita reimbursement, for Part A, reimbursement for direct (DME) and indirect medical education (IME) expenditures and disproportionate share expenditures (DSH), and the per capita expenditures with the medical education and disproportionate share expenditures removed. The adjusted or repriced spreadsheets for Aged and Disabled reflect the annual impact of the repricing of 2010-2014 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 wage index or 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 file. An additional adjustment to 2012, 2013, and 2014 claims to account for shared savings payments and shared losses are made to Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) and Pioneer ACOs. The dataset includes Aged beneficiaries repricing adjustments to the 2010-2014 skilled nursing facility reimbursement data to reflect the most current wage index (Data cells with less than 11 beneficiaries have been suppressed for privacy).

Date Created

2016-04-04

Last Modified

2016-04-04

Version

2016-04-04

Update Frequency

Annual

Temporal Coverage

2010-2014

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicaid and Medicare Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Cost Management, Medicare Cost, Medicare Fee for Service, FFS Insurance Medicare, FFS, FFS Cost, Medicare Spending per Beneficiaries, Fee for Service Reimbursement, Repricing of FFS Claims, Aged Skilled Nursing Facility Reimbursement

Other Titles

Aged Beneficiaries Reimbursement for Skilled Nursing Facility by State and County of Residence, Medicare Fee-for-Service Data for County by Age, Disabled, and ESRD Beneficiaries, Repricing Of FFS Claims Aged Skilled Nursing Facility Reimbursement by State and County of Residence

NameDescriptionTypeConstraints
FIPS_CodeIdentification codestringmaxLength : 5
StateName of statestringmaxLength : 24
CountyName of CountystringmaxLength : 30
Year_2010Repricing adjustments to the 2010 skilled nursing facility reimbursement data to reflect the most current wage indexnumberlevel : Ratio
Year_2011Repricing adjustments to the 2011 skilled nursing facility reimbursement data to reflect the most current wage indexnumberlevel : Ratio
Year_2012Repricing adjustments to the 2012 skilled nursing facility reimbursement data to reflect the most current wage indexnumberlevel : Ratio
Year_2013Repricing adjustments to the 2013 skilled nursing facility reimbursement data to reflect the most current wage indexnumberlevel : Ratio
Year_2014Repricing adjustments to the 2014 skilled nursing facility reimbursement data to reflect the most current wage indexnumberlevel : Ratio
FIPS_CodeStateCountyYear_2010Year_2011Year_2012Year_2013Year_2014
65XXXGUAMGUAM00000
49020VIRGINIAALLEGHANY
12030HAWAIIKALAWAO00000
40265PUERTO RICOFLORIDA
40145PUERTO RICOCANOVANAS
45741TEXASKING000-156-166
2140ALASKAKOBUK03081001514
40460PUERTO RICOMARICAO00000
45150TEXASBORDEN0-7840-48-458
45762TEXASLOVING-34726-69-3740