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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California Hospital Chargemasters

Overview:

  • A hospital charge description master, also known as a chargemaster or CDM, contains the prices of all services, goods, and procedures for which a separate charge exists. It is used to generate a patient’s bill.
  • As required by the Payers’ Bill of Rights, each hospital in California is required to submit a copy of its chargemaster, a list of average charges for 25 common outpatient procedures, and the estimated percentage change in gross revenue due to price changes each July 1.
  • It is important to note that the State of California does not currently possess the authority to set or limit the prices that are included on the submitted hospital chargemasters. Therefore, the Office of Statewide Health Planning & Development (OSHPD) is not able to provide an assessment on the accuracy of the submitted information
  • The chargemasters are currently not required to be provided in a standardized format. Therefore, it is currently not possible to generate an aggregate statewide chargemaster.
  • It doesnt seem like other states have such databases. Some hospital info can be found scattered online (example).
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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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