Medicare Provider Charge Data: Inpatient

Medicare Provider Charge Data: Inpatient

Description

 
The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for the Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges. 
 
Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service. The Total Payment amount includes the MS-DRG amount, bill total per diem, beneficiary primary payer claim payment amount, beneficiary Part A coinsurance amount, beneficiary deductible amount, beneficiary blood deducible amount and DRG outlier amount.

For these DRGs, average charges and average Medicare payments are calculated at the individual hospital level. Users will be able to make comparisons between the amount charged by individual hospitals within local markets, and nationwide, for services that might be furnished in connection with a particular inpatient stay.

For additional information, including National and State Summaries, click here.

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COMMENTS

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Alexandra Pappas's picture

@bduerst - The “Average Covered Charges” is what the provider is billing Medicare. The “Average Total Payments” is what Medicare pays the provider. The difference is not paid.

Thanks for your question!

bduerst's picture

What is the difference between "Average Covered Charges" and "Average Total Payments"?

Is it as simple as:
ACC = What the provider charges Medicare
ATP = What medicare actually pays to the provider

Alexandra Pappas's picture

@mohit - AWESOME! Don't forget to fill out the pre-registration form here: http://www.formstack.com/forms/?1490014-tlQrAEMhNP

Alexandra Pappas's picture

@soum - The data can be accessed in different formats, including via an API, at the following links:

https://data.cms.gov/Medicare/Inpatient-Prospective-Payment-System-IPPS-... (INPATIENT)

https://data.cms.gov/Medicare/Outpatient-Prospective-Payment-System-OPPS... (OUTPATIENT)

Thanks!

Mohit's picture

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soum's picture

These data sets are not really usable. The CSV doesn't have a header and can not be converted into any workable format. The XlS is also a bit useless. It would be helpful to have a data set which can be worked upon. Otherwise one would spend endless hours trying to make a dataset work (which is a very easy part if the dataset is provided in a correct format) than actually thinking about a powerful visualization. Making a dataset available through an API is very easy.

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