Skilled Nursing Facility Utilization and Payment Data 2015

$179 / year

This dataset provides information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility Public Use File contains information on utilization, payment (allowed amount, Medicare payment and standard payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by Centers for Medicare and Medicaid Services (CMS) Certification Number, Resource Utilization Group (RUG), and state of service.

Complexity

This dataset is created annually and contains dozens of variables that describe the characteristics of institutional Medicare providers. The primary data source for this dataset is CMS’s Chronic Conditions Data Warehouse (CCW). The CCW Part A and Part B data files contain 100 percent of Medicare final action claims for beneficiaries who are enrolled in the Fee-For-Service (FFS) program. The CCW Part A institutional claims and revenue center files, restricted to claims where the claim type code was “20” or “30” indicating that the claim was a Skilled Nursing Facility claim, were used to create the Skilled Nursing Facility Public Use File (PUF).

The data source for this data is the 2015 Long-Term Care Minimum Data Set 3.0 (MDS). The MDS is a standardized, primary screening and assessment tool of health status which forms the foundation of the comprehensive assessment for all residents (regardless of payer) of long-term care facilities certified to participate in Medicare or Medicaid. The MDS contains items that measure physical, clinical, psychological, psychosocial functioning, and life care wishes. Provider demographics are also incorporated into the Skilled Nursing Facility PUF including name and complete address from the CMS Provider of Services (POS) file.

Date Created

2017-07-29

Last Modified

2018-10-11

Version

2018-10-11

Update Frequency

Annual

Temporal Coverage

2015

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Skilled Nursing Facility, SNF Payment, SNF Charges, Skilled Nursing Facility 2015, Nursing Utilization and Payment Data

Other Titles

Medicare Skilled Nursing Facility Utilization and Payment Data 2015, Skilled Nursing Facility Payment Amounts 2015

NameDescriptionTypeConstraints
Provider_IDThe 6-digit identification number for the SNF on the claim.integerlevel : Nominal
Facility_NameThe SNF name, as reported in the POS file.string-
StreetAddress of SNF providerstring-
CityThe city where the SNF is located, as reported in the POS file.string-
State_AbbreviationThe state where the SNF is located, as reported in POS file. The fifty U.S. states and the District of Columbia are reported by the state postal abbreviation.string-
Zip_CodeThe SNF’s zip code, as reported in the POS file.integerlevel : Nominal
Total_StaysTotal count of stays provided by an SNF in the calendar year.numberlevel : Ratio
Distinct_Beneficiaries_Per_ProviderNumber of distinct Medicare beneficiaries with a least one SNF stay or SNF day in the calendar year. Beneficiaries may have more than one SNF stay or day per year but are only counted once in this field per row, however they may be double-counted across providers or RUGs. Therefore, this column will not sum to a total count of unique beneficiaries.numberlevel : Ratio
Average_Length_of_Stay_DaysAverage length of stay, in days.numberlevel : Ratio
Total_SNF_Charge_AmountTotal charges that the SNF submitted for stays.number-
Total_SNF_Medicare_Allowed_AmountTotal of the Medicare allowed amount for stays; this figure is the sum of the amount Medicare pays, the deductible and coinsurance amount that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.number-
Total_SNF_Medicare_Payment_AmountTotal amount that Medicare paid for the SNF stays after deductible and coinsurance amounts have been deducted.number-
Total_SNF_Medicare_Standard_Payment_AmountTotal amount that Medicare paid for SNF stays adjusted for geographic differences in payment rates.number-
Average_AgeAverage age of beneficiaries. Beneficiary age is calculated at the end of the calendar year or at the time of deathnumberlevel : Ratio
Male_BeneficiariesNumber of male beneficiaries.numberlevel : Ratio
Female_BeneficiariesNumber of female beneficiariesnumberlevel : Ratio
Nondual_BeneficiariesNumber of Medicare beneficiaries qualified to receive Medicare only benefits. Beneficiaries are classified as Medicare only entitlement if they received zero months of any Medicaid benefits (full or partial) in the given calendar year.numberlevel : Ratio
Dual_BeneficiariesNumber of Medicare beneficiaries qualified to receive Medicare and Medicaid benefits. Beneficiaries are classified as Medicare and Medicaid entitlement if in any month in the given calendar year they were receiving full or partial Medicaid benefitsnumberlevel : Ratio
White_BeneficiariesNumber of non-Hispanic white beneficiariesnumberlevel : Ratio
Black_BeneficiariesNumber of non-Hispanic black or African American beneficiaries.numberlevel : Ratio
Asian_Pacific_Islander_BeneficiariesNumber of Asian Pacific Islander beneficiaries.numberlevel : Ratio
Hispanic_BeneficiariesNumber of Hispanic beneficiariesnumberlevel : Ratio
American_Indian_Or_Alaska_Native_BeneficiariesNumber of American Indian or Alaska Native beneficiariesnumberlevel : Ratio
Other_Or_Unknown_BeneficiariesNumber of beneficiaries with race not elsewhere classified.numberlevel : Ratio
Average_HCC_ScoreAverage Hierarchical Condition Category (HCC) risk score of beneficiaries. Please refer to the “Additional Information” section of this document for more details on HCC risk scores.numberlevel : Ratio
Percent_of_Beneficiaries_With_Atrial_FibrillationPercent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation.numberlevel : Ratio
Percent_of_Beneficiaries_With_AlzheimersPercent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia.numberlevel : Ratio
Percent_of_Beneficiaries_With_AsthmaPercent of beneficiaries meeting the CCW chronic condition algorithm for Asthma.numberlevel : Ratio
Percent_of_Beneficiaries_With_CancerPercent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer.numberlevel : Ratio
Percent_of_Beneficiaries_With_CHFPercent of beneficiaries meeting the CCW chronic condition algorithm for heart failure.numberlevel : Ratio
Percent_of_Beneficiaries_With_Chronic_Kidney_DiseasePercent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease.numberlevel : Ratio
Percent_of_Beneficiaries_With_COPDPercent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease.numberlevel : Ratio
Percent_of_Beneficiaries_With_DepressionPercent of beneficiaries meeting the CCW chronic condition algorithm for depression.numberlevel : Ratio
Percent_of_Beneficiaries_With_DiabetesPercent of beneficiaries meeting the CCW chronic condition algorithm for diabetes.numberlevel : Ratio
Percent_of_Beneficiaries_With_HyperlipidemiaPercent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia.numberlevel : Ratio
Percent_of_Beneficiaries_With_HypertensionPercent of beneficiaries meeting the CCW chronic condition algorithm for hypertension.numberlevel : Ratio
Percent_of_Beneficiaries_With_IHDPercent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease.numberlevel : Ratio
Percent_of_Beneficiaries_With_OsteoporosisPercent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis.numberlevel : Ratio
Percent_of_Beneficiaries_with_Rheumatiod_Arthritis_OseoarthritisPercent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis.numberlevel : Ratio
Percent_of_Beneficiaries_With_SchizophreniaPercent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders.numberlevel : Ratio
Percent_of_Beneficiaries_With_StrokePercent of beneficiaries meeting the CCW chronic condition algorithm for stroke.numberlevel : Ratio
Provider_IDFacility_NameStreetCityState_AbbreviationZip_CodeTotal_StaysDistinct_Beneficiaries_Per_ProviderAverage_Length_of_Stay_DaysTotal_SNF_Charge_AmountTotal_SNF_Medicare_Allowed_AmountTotal_SNF_Medicare_Payment_AmountTotal_SNF_Medicare_Standard_Payment_AmountAverage_AgeMale_BeneficiariesFemale_BeneficiariesNondual_BeneficiariesDual_BeneficiariesWhite_BeneficiariesBlack_BeneficiariesAsian_Pacific_Islander_BeneficiariesHispanic_BeneficiariesAmerican_Indian_Or_Alaska_Native_BeneficiariesOther_Or_Unknown_BeneficiariesAverage_HCC_ScorePercent_of_Beneficiaries_With_Atrial_FibrillationPercent_of_Beneficiaries_With_AlzheimersPercent_of_Beneficiaries_With_AsthmaPercent_of_Beneficiaries_With_CancerPercent_of_Beneficiaries_With_CHFPercent_of_Beneficiaries_With_Chronic_Kidney_DiseasePercent_of_Beneficiaries_With_COPDPercent_of_Beneficiaries_With_DepressionPercent_of_Beneficiaries_With_DiabetesPercent_of_Beneficiaries_With_HyperlipidemiaPercent_of_Beneficiaries_With_HypertensionPercent_of_Beneficiaries_With_IHDPercent_of_Beneficiaries_With_OsteoporosisPercent_of_Beneficiaries_with_Rheumatiod_Arthritis_OseoarthritisPercent_of_Beneficiaries_With_SchizophreniaPercent_of_Beneficiaries_With_Stroke
65337ASPEN CENTER656 DILLON WAYAURORACO80011231624.325438926407521367521071968004.11193838253850695056696382519
175492PARK VILLA114 S HIGH STCLYDEKS669382218363020163235252391052921748218000001.82116722056282233563911612222
125009MALUHIA1027 HALA DRIVEHONOLULUHI96817343320.670707731205327756123507886122100300224732463352242452455245624
15407HEALTH CARE INCP O BOX 130ASHVILLEAL35953161131.92357102110051517851867767011000003.1518093673277355649455545
115675RETREAT, THE898 COLLEGE STMONTICELLOGA31064151514.812419175584610946503784110002.231320767405347535313671313
175346ALMA MANOR234 MANOR CIRCLEALMAKS66401221422.529246217970814159316236774130002.431443297577150574357291443507
175374EASTRIDGE1ST & MAIN RR 1CENTRALIAKS6641522172730170019387014362717606683160001.4812536671651271354724411218
115482EAST LAKE ARBOR304 FIFTH AVENUEDECATURGA30030252244.839799345398432987435904673110002.515415505945595552718
15452OAK PARK1365 GATEWOOD DRIVEAUBURNAL36830272223.213215617684411998614902883150002.052368181464413227505568941189
175484SALEM HOME704 S ASHHILLSBOROKS67063292525.93914052766162104662560368425000001.74365628125260445236646012562416