Repricing FFS Claims Dialysis PartA PartB

$179 / year

The dataset includes data for End-Stage Renal Disease (ESRD) beneficiaries or Dialysis for Part A Part B by state and county of residence. Medicare fee-for-service (FFS) data for each county broken down by aged, disabled, and 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 (FFS) data for each county broken down by aged, disabled, and ESRD beneficiaries including data on total Medicare fee-for-service 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 / 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 End-Stage Renal Disease (ESRD) beneficiaries or Dialysis – 2014 Enrollment, Reimbursement, Per Capita Cost (Monthly) For Part A And Part B By State. Beneficiaries Enrolled In Both Parts A And B

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, Dialysis, ESRD

Other Titles

End-Stage Renal Disease Beneficiaries For Part A And Part B By State and County of Residence, Medicare Fee-For-Service Data for County by Aged, Disabled, and ESRD Beneficiaries, Repricing Of FFS Claims End-Stage Renal Disease (ESRD) Beneficiaries by State and County of Residence

NameDescriptionTypeConstraints
FIPS_CodeIdentification codestring-
State_AbbreviationName of statestring-
PartA_Enrollment_MonthsMedicare Fee-For-Service Part A enrollmentnumberlevel : Ratio
PartA_Total_Reimbursement_In_ThousandsMedicare Fee-For-Service Part A total reimbursementnumberlevel : Ratio
PartA_Total_Per_CapitaMedicare Fee-For-Service Part A total per-capita expenditurenumberlevel : Ratio
PartA_IME_In_ThousandsMedicare Fee-For-Service Part A indirect medical education (IME) expendituresnumberlevel : Ratio
PartB_Enrollment_In_MonthsMedicare Fee-For-Service Part B enrollmentnumberlevel : Ratio
PartB_Total_Reimbursement_In_ThousandsMedicare Fee-For-Service Part B total reimbursementnumberlevel : Ratio
PartB_Total_Per_CapitaMedicare Fee-For-Service Part B total per-capita expenditurenumberlevel : Ratio
Risk_ScoreMedicare Fee-For-Service risk scorenumberlevel : Ratio
FIPS_CodeState_AbbreviationPartA_Enrollment_MonthsPartA_Total_Reimbursement_In_ThousandsPartA_Total_Per_CapitaPartA_IME_In_ThousandsPartB_Enrollment_In_MonthsPartB_Total_Reimbursement_In_ThousandsPartB_Total_Per_CapitaRisk_Score
2AK50061089321762154949205684155.980.9457
48VI235334761477.164230178433408.570.8777
63NMI13911016730.562132040823092.230.8332
64AS136515121107.9337127930702399.970.8154
65GU43823760858.16244253134603164.920.8203
53WY348273592113.41873443124333611.080.9418
43SD8124179022203.643338045294243657.40.9976
27MT7597130731720.761217534268713566.570.9699
35ND6146113541847.362776077202403330.640.9862
41RI7394226383061.6422047344318224333.11.0125