United States Health Information Knowledgebase

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Medicare Provider Charge Data

  • This is what hospitals charge for common inpatient services. It covers more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges for FY 2011.
  • These represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.
  • 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.
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National Provider Identifier Registry

Overview:

  • The National Provider Identifier (NPI) was adopted as the standard unique health identifier for health care providers to carry out a requirement in the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
  • The Centers for Medicare & Medicaid Services (CMS) then developed the National Plan and Provider Enumeration System (NPPES) to assign these unique identifiers.
  • Any entity who meets the definition of a “health care provider” is eligible to receive a provider ID, or NPI.  That would mean any provider of medical or other health services, and any other person or organization that furnishes, bills, or is paid for health care in the normal course of business.
  • Under HIPAA, a covered health care provider is any provider who transmits health information in electronic form in connection with a transaction for which standards have been adopted. These covered health care providers must obtain an NPI and use this number in all HIPAA transactions
  • The NPI Registry enables you to search for a provider’s NPPES information to retrieve read-only data. For example, users may search for a provider by the NPI or Legal Business Name.
  • It’s pretty well maintained. A covered health care provider must notify the NPPES of the address change within 30 days of the effective date of the change.
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CMS Healthcare Cost Report Information System

Overview:

  • Medicare-certified institutional providers are required to submit an annual cost report to a Fiscal Intermediary (FI).
  • The cost report contains provider information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data.
  • CMS maintains the cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS).
  • The following cost reports are available. Each fiscal year is a separate zipped file, except where noted specifically.
    1. Hospice (there is one zipped file that contains all data for all the fiscal years)
    2. Renal
    3. Hospital (because of the size, can’t be loaded in excel)
    4. SNF (Skilled Nursing Facilities- can’t be loaded in excel either)
    5. HHA (Home Health Agencies)
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Hospital Consumer Assessment of Healthcare Providers and Systems

Overview:

  • A standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care
  • Contains 18 patient perspectives on care and patient rating items that encompass eight key topics:
    1. communication with doctors
    2. communication with nurses
    3. responsiveness of hospital staff
    4. pain management
    5. communication about medicines
    6. discharge information
    7. cleanliness of the hospital environment
    8. quietness of the hospital environment.
  • The survey also includes four screening questions and five demographic items, which are used for adjusting the mix of patients across hospitals and for analytical purposes.
  • The survey is 27 questions in length.
  • Hospitals voluntarily do HCAHPS survey via paper, telephone or Interactive Voice Response.
  • Beginning in 2002, CMS partnered with AHRQ to develop and test the HCAHPS survey
  • In May 2005, NQF an organization established to standardize health care quality measurement and reporting, formally endorsed the CAHPS® Hospital Survey
  • The number of hospitals that publicly report HCAHPS results has increased from 2,521 in March 2008 to 3,774 in July 2010.
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