Repricing FFS Claims Aged

$179 / year

The dataset includes data for Aged beneficiaries for part A and part B 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 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 / 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 Organizations (ACO) and Pioneer ACOs. The dataset includes Aged beneficiaries enrollment, reimbursement, per capita cost (monthly) for part A and part B by state and county of residence. (Beneficiaries enrolled in parts A and/or B except for Puerto Rico were enrolled in both parts A and B. Reimbursements excluded for hospice and cost contracts. 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

Medicare Fee For Service, FFS Insurance Medicare, FFS, FFS Cost, Medicare Spending Per Beneficiaries, Fee For Service Reimbursement, Repricing Of FFS Claims, Aged Durable Medical Equipment Non-CBA, FFS Claims Aged

Other Titles

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

NameDescriptionTypeConstraints
FIPS_CodeIdentification codestring-
StateName of statestring-
CountyName of Countystring-
Part_A_EnrollmentMedicare Fee-For-Service Part A enrollmentnumberlevel : Ratio
Part_A_Total_ReimbursementMedicare Fee-For-Service Part A total reimbursementnumberlevel : Ratio
Part_A_Total_Per_CapitaMedicare Fee-For-Service Part A total per-capita expenditurenumberlevel : Ratio
Part_A_Total_Reimbursement_Without_IME_DSH_DMEMedicare Fee-For-Service Part A total reimbursement without direct (DME) and indirect (IME) medical education expenditures and disproportionate share expenditures (DSH)numberlevel : Ratio
Part_A_Total_Per_Capita_Without_IME_DSH_DMEMedicare Fee-For-Service Part A total per-capita expenditure without direct (DME) and indirect (IME) medical education expenditures and disproportionate share expenditures (DSH)numberlevel : Ratio
Part_A_IMEMedicare Fee-For-Service Part A indirect medical education (IME) expendituresnumberlevel : Ratio
Part_A_DSHMedicare Fee-For-Service Part A disproportionate share expenditures (DSH)numberlevel : Ratio
Part_A_DMEMedicare Fee-For-Service Part A direct medical education expenditure (DME)numberlevel : Ratio
Part_B_EnrollmentMedicare Fee-For-Service Part B enrollmentnumberlevel : Ratio
Part_B_Total_ReimbursementMedicare Fee-For-Service Part B total reimbursementnumberlevel : Ratio
Part_B_Total_Per_CapitaMedicare Fee-For-Service Part B total per-capita expenditurenumberlevel : Ratio
Aged_And_Disabled_Mean_Risk_ScoreMedicare Fee-For-Service data for aged and disabled mean risk scorenumberlevel : Ratio
FIPS_CodeStateCountyPart_A_EnrollmentPart_A_Total_ReimbursementPart_A_Total_Per_CapitaPart_A_Total_Reimbursement_Without_IME_DSH_DMEPart_A_Total_Per_Capita_Without_IME_DSH_DMEPart_A_IMEPart_A_DSHPart_A_DMEPart_B_EnrollmentPart_B_Total_ReimbursementPart_B_Total_Per_CapitaAged_And_Disabled_Mean_Risk_Score
49020VIRGINIAALLEGHANY
40265PUERTO RICOFLORIDA
40460PUERTO RICOMARICAO
40145PUERTO RICOCANOVANAS
49565VIRGINIAMANASSAS PARK CITY
45741TEXASKING2063302263.7663225263.4407702082130342.210.69
40440PUERTO RICOLUQUILLO46688612.47688612.470004675419136.630.92
28420NEBRASKAHAYES83280817281.94279731280.851099017583375447376.951
45762TEXASLOVING1215956110.811292189.73126658811801125194190.860.66
11420GEORGIAECHOLS98210888179.33204705174.0706183093362881325.161.04