1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ **** Medicare Provider Analysis REC 838 The representation of a beneficiary stay in an Inpatient and Review (MEDPAR) hospital or in a skilled nursing facility (SNF) which may Expanded Modified Record include one or more final action claims. The 1995 Medicare provider analysis and review (MEDPAR) file contains data from claims for services provided to Medicare beneficiaries admitted to Medicare-certified hospitals and skilled nursing facilities (SNF). The file is created quarterly in March, June, September, and December, and is generally available two weeks after the end of the quarter. Each MEDPAR record represents a beneficiary stay in an Inpatient hospital (where discharged) or in a SNF (may be 'still a patient'; complete discharge data not always received), and may include one claim or multiple claims. (Approximately 95% of Inpatient MEDPAR records and 50% of SNF MEDPAR records involve a single claim.) Beginning in June 1995, the Inpatient and SNF claims from the national claims history (NCH) 100% nearline file became the source of MEDPAR. Also effective June, 1995, a MEDPAR record represents final action claims data in which all adjustments have been resolved (thereby eliminating credit-only situations). (Prior to June 1995, MEDPAR was created from claims from the Medicare quality assurance (MQA) system; a MEDPAR record represented an accumulation of adjustment claims, sometimes including credit-only stays.) Effective with the 9/96 update the 1995 MEDPAR was created as follows: 1. Each month Inpatient and SNF claims are accumulated from the NCH nearline repository. 2. At the end of each quarter, the monthly files are merged into a database containing all claims for the current year and prior two years. The database is processed through the final action algorithms. 3. The final-actioned database is split into two segments for each year. Inpatient claims with discharge dates and SNF claims with admission dates in January through September are in the first segment; claims with dates in October through December are in the second segment. This allows for the creation of fiscal year or calendar year files as needed. 4. The claims remaining from the final action processing are collapsed by claim number, admission date, and provider number (all in ascending order) to create a stay record. The records are further sorted by claim from date, claim thru date, (both in ascending order), HCFA process date (descending), and query code (descending); and the results are used to create MEDPAR. 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ For the 6/95 through the 6/96 updates the 1995 MEDPAR was created as follows: * Each month Inpatient and SNF claims are accumulated from the NCH nearline repository. * At the end of each quarter, the monthly files are merged into a database containing all claims for the current year and prior two years. The database is split into two segments for each year. Inpatient claims with discharge dates and SNF claims with admission dates in January through September are in the first segment; claims with dates in October through December are in the second segment. This allows for the creation of fiscal year or calendar year files as needed. * The segments are processed through the final action algorithms. The claims remaining from the final action processing are collapsed by claim number, admission date, and provider number (all in ascending order) to create a stay record. The records are further sorted by claim from date, claim thru date, (both in ascending order), HCFA process date (descending), and query code (descending); and the results are used to create MEDPAR. SYSTEM ALIAS: MED2K788 **** DESY Header Group GROUP 50 1 50 1. DESY System User CHAR 30 1 30 A user-defined field that holds the description of the request. For example, cross-referenced HICs. 2. DESY Filler CHAR 11 31 41 Filler 3. DESY Sort Key CHAR 9 42 50 This field contains the key to tie claims together for one beneficiary regardless of HICAN. **** MEDPAR Claim Locator Number GROUP 11 51 61 THIS NUMBER UNIQUELY IDENTIFIES THE BENEFICIARY. Group STANDARD ALIAS: MEDPAR_CLM_LCTR_NUM_GRP 4. MEDPAR Beneficiary Claim CHAR 9 51 59 The number identifying the primary beneficiary under the SSA Account Number or RRB programs submitted. NOTE: This field comes from the CAN that is present on the first claim record included in the stay. COMMON ALIAS: CAN DB2 ALIAS: BENE_CLM_ACNT_NUM SAS ALIAS: CAN STANDARD ALIAS: MEDPAR_BENE_CLM_ACNT_NUM SOURCE: NCH 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 5. MEDPAR Category Equatable CHAR 2 60 61 The code which categorizes groups of BICs representing Beneficiary Identification similar relationships between the beneficiary and the Code primary wage earner. The equatable BIC module electronically matches two records that contain different BICs where it is apparent that both are records for the same beneficiary. It validates the BIC and returns a base BIC under which to house the record in the national claims history (NCH) databases. (All records for a beneficiary are stored under a single BIC.) NOTE: This field comes from the NCH category base BIC that is present on the first claim record included in the stay. COMMON ALIAS: EQ_BIC DB2 ALIAS: CTGRY_EQTBL_BIC SAS ALIAS: EQ_BIC STANDARD ALIAS: MEDPAR_CTGRY_EQTBL_BIC_CD CODES: REFER TO: CTGRY_EQTBL_BENE_IDENT_TB IN THE CODES APPENDIX SOURCE: NCH 6. MEDPAR Beneficiary Age NUM 3 62 64 The beneficiary's age as of date of admission. Count 3 DIGITS UNSIGNED DB2 ALIAS: MEDPAR_AGE_CNT SAS ALIAS: AGE_CNT STANDARD ALIAS: MEDPAR_BENE_AGE_CNT DERIVATION: This field is derived by subtracting the bene date of birth from the admission date, present on the first claim record included in the stay. Exception: If the resulting age is 64, and the MSC = 10 or 11, the age is changed to 65. SOURCE: NCH 7. MEDPAR Beneficiary Sex Code CHAR 1 65 65 The sex of a beneficiary. NOTE: This field comes from the sex code that is present on the first claim record included in the stay. COMMON ALIAS: SEX DB2 ALIAS: BENE_SEX_IDENT_CD SAS ALIAS: SEX STANDARD ALIAS: MEDPAR_BENE_SEX_CD SYSTEM ALIAS: LTSEX 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ CODES: 1 = Male 2 = Female 0 = Unknown SOURCE: NCH 8. MEDPAR Beneficiary Race CHAR 1 66 66 The race of a beneficiary. Code NOTE: This field comes from the race code that is present on the first claim record included in the stay. COMMON ALIAS: RACE DB2 ALIAS: BENE_RACE_CD SAS ALIAS: RACE STANDARD ALIAS: MEDPAR_BENE_RACE_CD SYSTEM ALIAS: LTRACE CODES: 0 = Unknown 1 = White 2 = Black 3 = Other 4 = Asian 5 = Hispanic 6 = North American Native SOURCE: NCH 9. MEDPAR Beneficiary Medicare CHAR 2 67 68 The CWF-derived reason for a beneficiary's entitlement to Status Code Medicare benefits, as of the reference date (CLM_THRU_DT). COMMON ALIAS: MSC DB2 ALIAS: BENE_MDCR_STUS_CD SAS ALIAS: MS_CD STANDARD ALIAS: MEDPAR_BENE_MDCR_STUS_CD SYSTEM ALIAS: LTMSC DERIVATION: CWF derives MSC from the following: 1. Date of birth 2. Claim through date 3. Original/Current reasons for entitlement 4. ESRD indicator 5. Beneficiary claim number Items 1,3,4,5 come from the CWF beneficiary master record; Item 2 comes from the FI/Carrier claim record. MSC is assigned as follows: 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ MSC OASI DIB ESRD AGE BIC _____ ______ _____ ______ _____ _____ 10 YES N/A NO 65 AND OVER N/A 11 YES N/A YES 65 AND OVER N/A 20 NO YES NO UNDER 65 N/A 21 NO YES YES UNDER 65 N/A 31 NO NO YES ANY AGE T. CODES: 10 = Aged without ESRD 11 = Aged with ESRD 20 = Disabled without ESRD 21 = Disabled with ESRD 31 = ESRD only SOURCE: NCH **** MEDPAR Beneficiary State GROUP 5 69 73 County Group 10. MEDPAR Beneficiary CHAR 2 69 70 The SSA standard state code of a beneficiary's residence. Residence SSA Standard State Code NOTE: This field comes from the state code that is present on the first claim record included in the stay. COMMON ALIAS: STATE DB2 ALIAS: BENE_SSA_STATE_CD SAS ALIAS: STATE_CD STANDARD ALIAS: MEDPAR_BENE_RSDNC_SSA_STATE_CD SYSTEM ALIAS: LTSTATE CODES: REFER TO: GEO_SSA_STATE_TB IN THE CODES APPENDIX SOURCE: NCH 11. MEDPAR Beneficiary CHAR 3 71 73 The SSA standard county code of a beneficiary's residence. Residence SSA Standard County Code NOTE: This field comes from the county code that is present on the first claim record included in the stay. COMMON ALIAS: COUNTY_CODE DB2 ALIAS: BENE_SSA_CNTY_CD SAS ALIAS: CNTY_CD STANDARD ALIAS: MEDPAR_BENE_RSDNC_SSA_CNTY_CD SOURCE: NCH 12. MEDPAR Beneficiary Mailing CHAR 5 74 78 The zip code of the mailing address where the beneficiary Contact Zip Code may be contacted. 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ NOTE: This field comes from the zip code that is present on the first claim record included in the stay. COMMON ALIAS: ZIP_CODE DB2 ALIAS: BENE_MLG_ZIP_CD SAS ALIAS: BENE_ZIP STANDARD ALIAS: MEDPAR_BENE_MLG_CNTCT_ZIP_CD SOURCE: NCH 13. FILLER CHAR 4 79 82 14. MEDPAR Admission Day Code NUM 1 83 83 The code indicating the day of the week on which the beneficiary was admitted to a facility. 1 DIGIT UNSIGNED COMMON ALIAS: DAY_OF_ADMISSION DB2 ALIAS: ADMSN_DAY_CD SAS ALIAS: ADMSNDAY STANDARD ALIAS: MEDPAR_ADMSN_DAY_CD DERIVATION: This field is derived from the admission date that is present on the first claim record included in the stay. CODES: 1 = Sunday 2 = Monday 3 = Tuesday 4 = Wednesday 5 = Thursday 6 = Friday 7 = Saturday SOURCE: NCH 15. MEDPAR Beneficiary CHAR 1 84 84 The code used to identify the status of the patient as of Discharge Status Code the CLM_THRU_DT. COMMON ALIAS: DISCHARGE_STATUS DB2 ALIAS: MEDPAR_DSCHRG_CD SAS ALIAS: DSCHRGCD STANDARD ALIAS: MEDPAR_BENE_DSCHRG_STUS_CD DERIVATION: This field is derived from the claim status code that is present on the last claim record included in the stay. 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ CODES: A = Discharged alive (claim status code other than 20 or 30) B = Discharged dead (claim status code = 20) C = Still a patient (claim status code = 30) SOURCE: NCH 16. MEDPAR GHO Paid Code CHAR 1 85 85 The code indicating whether or not a GHO has paid the provider for the claim(s). NOTE: This field comes from the GHO-paid indicator that is present on the first claim record included in the stay. COMMON ALIAS: HMO_PAID_INDICATOR DB2 ALIAS: MEDPAR_GHO_PD_CD SAS ALIAS: GHOPDCD STANDARD ALIAS: MEDPAR_GHO_PD_CD CODES: 1 = GHO has paid the provider Blank Or 0 = GHO has not paid the provider SOURCE: NCH 17. MEDPAR PPS Indicator Code CHAR 1 86 86 The code indicating whether or not the facility is being paid under the prospective payment system (PPS). COMMON ALIAS: PPS_INDICATOR DB2 ALIAS: MEDPAR_PPS_IND_CD SAS ALIAS: PPS_IND STANDARD ALIAS: MEDPAR_PPS_IND_CD DERIVATION: If the condition code not equal 65 on all of the claims included in the stay and the third position of the provider number is numeric set MEDPAR_PPS_IND_CD to 2 (PPS). Otherwise set it to 0 (Non PPS.) CODES: 0 = Non PPS 2 = PPS SOURCE: NCH **** MEDPAR Provider Number GROUP 6 87 92 Group 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 18. MEDPAR Provider State Code NUM 2 87 88 The first two positions of the provider number, identifying the state of the institutional provider that furnished services to the beneficiary during the stay. 2 DIGITS UNSIGNED COMMON ALIAS: PROVIDER_STATE DB2 ALIAS: MEDPAR_PRVDR_STATE SAS ALIAS: PRVSTATE STANDARD ALIAS: MEDPAR_PRVDR_STATE_CD SYSTEM ALIAS: LTSTATE DERIVATION: This field comes from positions 1 & 2 of the provider number that is present on the first claim record included in the stay. CODES: REFER TO: GEO_SSA_STATE_TB IN THE CODES APPENDIX SOURCE: NCH 19. MEDPAR Provider Number CHAR 1 89 89 The third position of the provider number, identifying the Third Position Code category of institutional provider that furnished services to the beneficiary during the stay. COMMON ALIAS: PROVIDER_CATEGORY DB2 ALIAS: PRVDR_NUM_3RD_CD SAS ALIAS: PRVNUM3 STANDARD ALIAS: MEDPAR_PRVDR_NUM_3RD_CD DERIVATION: This field is position 3 of the provider number from the first claim record included in the stay modified as follows: Where position 3 is an alpha character it is moved to the MEDPAR provider number special unit code and replaced with '0'. SOURCE: NCH 20. MEDPAR Provider Number CHAR 3 90 92 The last three positions of the provider number, identifying Serial Code the specific serial numbers of the institutional provider that furnished services to the beneficiary during the stay. COMMON ALIAS: PROVIDER_SEQUENCE_NUMBER DB2 ALIAS: MEDPAR_SRL_CD SAS ALIAS: PRVDRSRL STANDARD ALIAS: MEDPAR_PRVDR_NUM_SRL_CD 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DERIVATION: This field comes from positions 4 - 6 of the provider number on the first claim record included in the stay. SOURCE: NCH 21. MEDPAR Provider Number CHAR 1 93 93 The code identifying the special numbering system for units Special Unit Code of hospitals that are excluded from PPS or hospitals with SNF swing-bed designation. COMMON ALIAS: SPECIAL_UNIT DB2 ALIAS: MEDPAR_SPCL_CD SAS ALIAS: SPCLUNIT STANDARD ALIAS: MEDPAR_PRVDR_NUM_SPCL_UNIT_CD DERIVATION: If the third position of the provider number from the first claim record included in the stay equals 'S', 'T', 'U', 'W', 'Y' or 'Z', it is moved to this field, otherwise it is blank. CODES: S = PPS-exempt psychiatric unit T = PPS-exempt rehabilitation unit U = Swing-bed short-term/acute care hospital W = Swing-bed long-term hospital Y = Swing-bed rehabilitation hospital Z = Swing-bed rural primary care hospital; eff. 10/97 changed to critical access hospitals Blanks = Not PPS-exempt or swing-bed designation SOURCE: NCH 22. MEDPAR Short Stay/Long CHAR 1 94 94 The code indicating whether the stay is a short stay, long Stay/SNF Indicator Code stay, or SNF. COMMON ALIAS: STAY_INDICATOR DB2 ALIAS: SS_LS_SNF_IND_CD SAS ALIAS: SSLSSNF STANDARD ALIAS: MEDPAR_SS_LS_SNF_IND_CD DERIVATION: This field is derived from the third position of the provider number that is present on the first claim record included in the stay. CODES: N = SNF Stay (Prvdr3 = 5, 6, U, W, Y, or Z) S = Short-Stay (Prvdr3 = 0, S, T) L = Long-Stay (All Others) 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ SOURCE: NCH 23. MEDPAR Stay Final Action NUM 4 95 98 The count of the number of claim records (final action) Claims Count included in the stay. 3 DIGITS SIGNED COMMON ALIAS: NUMBER_OF_BILLS DB2 ALIAS: FINL_ACTN_CLM_CNT SAS ALIAS: FACLMCNT STANDARD ALIAS: MEDPAR_STAY_FINL_ACTN_CLM_CNT DERIVATION: This field is derived by counting the number of final action claims used to create the stay. SOURCE: NCH 24. MEDPAR Latest Claim NUM 7 99 105 The date the latest claim record included in the stay was Accretion Date accreted (posted/processed) to the beneficiary master record at the CWF host). 7 DIGITS UNSIGNED COMMON ALIAS: ACCRETION_DATE DB2 ALIAS: LTST_ACRTN_DT SAS ALIAS: ACRTNDT STANDARD ALIAS: MEDPAR_LTST_CLM_ACRTN_DT EDIT-RULES: YYYYDDD DERIVATION: This field comes from the highest accretion date that is present on the claim records included in the stay. SOURCE: NCH 25. MEDPAR Beneficiary Medicare NUM 7 106 112 The last date for which the beneficiary had Medicare Benefit Exhausted Date coverage. This field is completed only where benefits were exhausted before the discharge date and during the period covered by stay. 7 DIGITS UNSIGNED COMMON ALIAS: EXHAUSTED_BENEFITS_DATE DB2 ALIAS: MDCR_BNFT_EXHST_DT SAS ALIAS: EXHST_DT STANDARD ALIAS: MEDPAR_BENE_MDCR_BNFT_EXHST_DT EDIT-RULES: YYYYDDD 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DERIVATION: This field comes from the highest benefits exhausted date that is present on the claim records included in the stay. SOURCE: NCH 26. MEDPAR SNF Qualification NUM 7 113 119 The beginning date of the beneficiary's qualifying stay. From Date For Inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization to benefits. For SNF claims, the date relates to the qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'a', or at least three days in a row if the source of admission is other than an 'a'. 7 DIGITS UNSIGNED DB2 ALIAS: QLFY_STAY_FROM_DT SAS ALIAS: QLFYFROM STANDARD ALIAS: MEDPAR_SNF_QUALN_FROM_DT EDIT-RULES: YYYYDDD DERIVATION: This field comes from occurrence span code = 70 and related occurrence span from date, if present on any of the claim records included in the stay. If more than one record has an occurrence span code = 70, with different span dates, teh date from the last claim record included in the stay is used. SOURCE: NCH 27. MEDPAR SNF Qualification NUM 7 120 126 The ending date of the beneficiary's qualifying stay. For Through Date Inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization to benefits. For SNF claims, the date relates to the qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'A', or at least three days in a row if the source of admission is other than an 'A'. 7 DIGITS UNSIGNED DB2 ALIAS: QUALN_STAY_THRU_DT SAS ALIAS: QLFYTHRU STANDARD ALIAS: MEDPAR_SNF_QUALN_THRU_DT EDIT-RULES: YYYYDDD 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DERIVATION: This field comes from the occurrence span code = 70 and related occurrence span thru date, if present on any of the claims included in the stay. If more than one record has an occurrence span code = 70, with different span dates, the date from the last claim record included in the stay is used. SOURCE: NCH 28. MEDPAR Admission Date NUM 7 127 133 The date the beneficiary was admitted for Inpatient care or the date that care started. NOTE: This field comes from the admission date that is present on the first claim record included in the stay. 7 DIGITS UNSIGNED COMMON ALIAS: ADMISSION_DATE DB2 ALIAS: MEDPAR_ADMSN_DT SAS ALIAS: ADMSNDT STANDARD ALIAS: MEDPAR_ADMSN_DT EDIT-RULES: YYYYDDD SOURCE: NCH 29. MEDPAR Discharge Date NUM 7 134 140 The date on which the beneficiary was discharged or died. NOTE: This field comes from the highest claim thru date that is present on the claim records included in the stay, where the claim status code is other than '30' (still patient) on the last claim record included in the stay. Inpatient claims will always have a discharge date; SNF claims could have a zero date. 7 DIGITS UNSIGNED COMMON ALIAS: DISCHARGE_DATE DB2 ALIAS: MEDPAR_DSCHRG_DT SAS ALIAS: DSCHRGDT STANDARD ALIAS: MEDPAR_DSCHRG_DT EDIT-RULES: YYYYDDD SOURCE: NCH 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 30. MEDPAR Covered Level Care NUM 7 141 147 The date on which a covered level of care ended in a SNF. Thru Date 7 DIGITS UNSIGNED COMMON ALIAS: DATE_CARE_ENDED DB2 ALIAS: CVR_LVL_THRU_DT SAS ALIAS: CVRLVLDT STANDARD ALIAS: MEDPAR_CVR_LVL_CARE_THRU_DT EDIT-RULES: YYYYDDD DERIVATION: This field comes from the date associated with occurrence code = 22 if present on any of the claims included in the stay. If multiple dates, the highest date is used. This field is only applicable to SNF claims. SOURCE: NCH 31. MEDPAR Beneficiary Death NUM 7 148 154 The date the beneficiary died. Date 7 DIGITS UNSIGNED DB2 ALIAS: BENE_DEATH_DT SAS ALIAS: DEATHDT STANDARD ALIAS: MEDPAR_BENE_DEATH_DT EDIT-RULES: YYYYDDD DERIVATION: This field comes from the beneficiary death date, if present on the enrollment database, which is accessed prior to creation of the quarterly MEDPAR file. SOURCE: EDB LIMITATIONS: REFER TO: MEDPAR_DOD_LIM IN THE LIMITATIONS APPENDIX 32. MEDPAR Beneficiary Death CHAR 1 155 155 The code indicating whether the beneficiary's date of death Date Verified Code has been verified (SOURCE: SSA's MBR) or originated from a claim record. COMMON ALIAS: DEATH_INDICATOR DB2 ALIAS: DEATH_DT_VRFY_CD SAS ALIAS: DEATHCD STANDARD ALIAS: MEDPAR_BENE_DEATH_DT_VRFY_CD 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DERIVATION: This field is derived from the enrollment database's beneficiary source death date code, or from the presence of a claim status code = '20' (expired) on the last claim record included in the stay. CODES: V = Date of death verified (EDB received DOD from SSA's MBR) B = Date of death taken from claim (EDB received DOD from claim) N = Date of death not verified (neither V or B applicable, but claim status code indicated death) Space = No date of death indicated SOURCE: EDB,NCH **** MEDPAR Internal Use SSI GROUP 6 156 161 STANDARD ALIAS: MEDPAR_INTRNL_USE_SSI_GRP Group 33. MEDPAR Internal Use SSI CHAR 1 156 156 DB2 ALIAS: INTRNL_USE_SSI_CD Indicator Code SAS ALIAS: SSICD STANDARD ALIAS: MEDPAR_INTRNL_USE_SSI_IND_CD COMMENT: Limited availability; for internal use only; applicable to Inpatient claims only. Where not available, this field is blank. 34. MEDPAR Internal Use SSI Day NUM 4 157 160 3 DIGITS SIGNED Count DB2 ALIAS: SSI_DAY_CNT SAS ALIAS: SSIDAY STANDARD ALIAS: MEDPAR_INTRNL_USE_SSI_DAY_CNT COMMENT: Limited availability; for internal use; applicable to Inpati claims only. Where not available, this field will contain zeroes. 35. FILLER CHAR 1 161 161 36. MEDPAR Length of Stay Day NUM 6 162 167 The count in days of the total length of a beneficiary's Count stay in a hospital or SNF. 5 DIGITS SIGNED COMMON ALIAS: LENGTH_OF_STAY DB2 ALIAS: MEDPAR_LOS_DAY_CNT SAS ALIAS: LOSCNT STANDARD ALIAS: MEDPAR_LOS_DAY_CNT 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DERIVATION: This field is derived by subtracting the date of discharge (or thru date in SNF cases where beneficiary is still a patient) from the date of admission. If difference is '0,' the value becomes a '1.' SOURCE: NCH 37. MEDPAR Outlier Day Count NUM 4 168 171 The count of the number of days paid as outliers (either a day or cost outlier) under PPS beyond the DRG threshold. 3 DIGITS SIGNED COMMON ALIAS: OUTLIER_DAYS DB2 ALIAS: OUTLIER_DAY_CNT SAS ALIAS: OUTLRDAY STANDARD ALIAS: MEDPAR_OUTLIER_DAY_CNT DERIVATION: This field is derived by checking the MEDPAR utilization day count against the DRG threshold table (DRG weights file). SOURCE: MEDPAR 38. MEDPAR Utilization Day NUM 4 172 175 The count of the number of covered days of care that are Count chargeable to Medicare utilization for the stay. 3 DIGITS SIGNED COMMON ALIAS: COVERED_DAYS DB2 ALIAS: UTLZTN_DAY_CNT SAS ALIAS: UTIL_DAY STANDARD ALIAS: MEDPAR_UTLZTN_DAY_CNT DERIVATION: This field is derived by accumulating the utilization day count that is present on any of the claim records included in the stay (i.e., the sum of utilization days reported on the claims that comprise the stay). SOURCE: NCH 39. MEDPAR Beneficiary Total NUM 4 176 179 The count of the total number of coinsurance days involved Coinsurance Day Count with the beneficiary's stay in a facility. For Inpatient services, the beneficiary is liable for a daily coinsurance amount after the 60th day and before the 91st day in a single spell of illness; for SNF services, the beneficiary is liable for a daily coinsurance amount after the 20th day and before the 101st day in a single spell of illness. 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 3 DIGITS SIGNED COMMON ALIAS: COINSURANCE_DAYS DB2 ALIAS: COINSRNC_DAY_CNT SAS ALIAS: COIN_DAY STANDARD ALIAS: MEDPAR_TOT_COINSRNC_DAY_CNT DERIVATION: This field is derived by accumulating the coinsurance day count that is present on any of the claim records included in the stay (i.e., the sum of coinsurance days reported on the claims that comprise the stay). SOURCE: NCH 40. MEDPAR Beneficiary LRD Used NUM 4 180 183 The count of the number of lifetime reserve days (LRD) used Count by the beneficiary for this stay. 3 DIGITS SIGNED COMMON ALIAS: LIFETIME_RESERVE_DAYS DB2 ALIAS: BENE_LRD_USE_CNT SAS ALIAS: LRD_USE STANDARD ALIAS: MEDPAR_BENE_LRD_USE_CNT DERIVATION: This field is derived by accumulating the lifetime reserve days used count that is present on any of the claim records included in the stay (i.e., the sum of LRD reported on the claims that comprise the stay). SOURCE: NCH 41. FILLER CHAR 12 184 195 42. MEDPAR Beneficiary Part A NUM 8 196 203 The amount of money (rounded to whole dollars) identified Coinsurance Liability as the beneficiary's liability for part A coinsurance for Amount the stay. 7 DIGITS SIGNED COMMON ALIAS: COINSURANCE_AMOUNT DB2 ALIAS: PTA_COINSRNC_AMT SAS ALIAS: COIN_AMT STANDARD ALIAS: MEDPAR_BENE_PTA_COINSRNC_AMT EDIT-RULES: +$$$$$$$ 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DERIVATION: This field is derived by accumulating the beneficiary's part a coinsurance liability amount that is present on any of the claim records included in the stay (i.e., the sum of coinsurance amounts reported on the claims that comprise the stay). SOURCE: NCH 43. MEDPAR Beneficiary NUM 8 204 211 The amount of money (rounded to whole dollars) identified as Inpatient Deductible the beneficiary's liability for the Inpatient deductible for Liability Amount the stay. 7 DIGITS SIGNED COMMON ALIAS: INPATIENT_DEDUCTIBLE DB2 ALIAS: BENE_IP_DDCTBL_AMT SAS ALIAS: DED_AMT STANDARD ALIAS: MEDPAR_BENE_IP_DDCTBL_AMT EDIT-RULES: +$$$$$$$ Rounded; On-size (overflow) Situation = All nines DERIVATION: This field is derived by accumulating the beneficiary Inpatient deductible amount that is present on any of the claim records included in the stay (i.e., the sum of the Inpatient deductibles reported on the claims that comprise the stay). SOURCE: NCH 44. MEDPAR Beneficiary Blood NUM 8 212 219 The amount of money (rounded to whole dollars) identified as Deductible Liability Amount the beneficiary's liability for the blood deductible for the stay. 7 DIGITS SIGNED COMMON ALIAS: BLOOD_DEDUCTIBLE DB2 ALIAS: BLOOD_DDCTBL_AMT SAS ALIAS: BLDDEDAM STANDARD ALIAS: MEDPAR_BENE_BLOOD_DDCTBL_AMT EDIT-RULES: +$$$$$$$ Rounded; On-size (overflow) Situation = All nines 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ DERIVATION: This field is derived by accumulating the beneficiary blood deductible liability amount that is present on any of the claim records included in the stay (i.e., the sum of the blood deductibles reported on the claims that comprise the stay). SOURCE: NCH 45. MEDPAR Beneficiary Primary NUM 8 220 227 The amount of payment (rounded to whole dollars) made on Payer Amount behalf of the beneficiary by a primary payer other than Medicare, which has been applied to the covered Medicare charges for the stay. 7 DIGITS SIGNED COMMON ALIAS: PRIMARY_PAYER_AMOUNT DB2 ALIAS: BENE_PRMRY_PYR_AMT SAS ALIAS: PRPAYAMT STANDARD ALIAS: MEDPAR_BENE_PRMRY_PYR_AMT EDIT-RULES: +$$$$$$$ Rounded; On-size (overflow) situation = All nines DERIVATION: This field is derived by accumulating the beneficiary primary payer payment amount that is present on any of the claim records included in the stay (i.e., the sum of the primary payer amounts reported on the claims that comprise the stay). SOURCE: NCH 46. MEDPAR DRG Outlier Approved NUM 8 228 235 The amount of additional payment (rounded to whole dollars) Payment Amount approved due to an outlier situation over the DRG allowance for the stay. 7 DIGITS SIGNED COMMON ALIAS: OUTLIER_AMOUNT DB2 ALIAS: OUTLIER_PMT_AMT SAS ALIAS: OUTLRAMT STANDARD ALIAS: MEDPAR_DRG_OUTLIER_PMT_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the DRG outlier approved payment amount (value code = 17 amount) that is 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ present on any of the claim records included in the stay (i.e., the sum of outlier amounts reported on the claims that comprise the stay). COMMENT: THIS AMOUNT IS ALREADY INCLUDED IN THE MEDPAR MEDICARE PAYMENT AMOUNT. SOURCE: NCH 47. MEDPAR Inpatient NUM 8 236 243 The amount paid over the DRG amount (rounded to whole Disproportionate Share dollars) for the disproportionate share hospital for the Amount stay. 7 DIGITS SIGNED COMMON ALIAS: DISPROPORTIONATE_SHARE DB2 ALIAS: DSPRPRTNT_SHR_AMT SAS ALIAS: DISP_SHR STANDARD ALIAS: MEDPAR_IP_DSPRPRTNT_SHR_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the value amount associated with value code = 18 that is present on any of the claim records included in the stay (i.e., the sum of value code 18 amounts reported on the claims that comprise the stay). COMMENT: THIS AMOUNT IS ALREADY INCLUDED IN THE MEDPAR MEDICARE PAYMENT AMOUNT. SOURCE: NCH 48. MEDPAR Indirect Medical NUM 8 244 251 The amount of additional payment (rounded to whole dollars) Education (IME) Amount made to teaching hospitals for IME for the stay. 7 DIGITS SIGNED DB2 ALIAS: MEDPAR_IME_AMT SAS ALIAS: IME_AMT STANDARD ALIAS: MEDPAR_IME_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the value amount associated with value code = 19 that is present on any of 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ the claim records included in the stay (i.e., the sum of IME amounts - value code 19 amounts - reported on the claims that comprise the stay). COMMENT: This amount is already included in the MEDPAR Medicare payme amount. SOURCE: NCH 49. MEDPAR DRG Price Amount NUM 8 252 259 The amount (called the 'DRG price' for purposes of MEDPAR analysis) that would have been paid if no deductibles, coinsurance, primary payers, or outliers were involved (rounded to whole dollars). 7 DIGITS SIGNED COMMON ALIAS: DRG_PRICE DB2 ALIAS: DRG_PRICE_AMT SAS ALIAS: DRGPRICE STANDARD ALIAS: MEDPAR_DRG_PRICE_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the following amounts: MEDPAR Medicare payment amount, MEDPAR beneficiary primary payer payment amount, MEDPAR beneficiary coinsurance liability amount, MEDPAR beneficiary Inpatient deductible liability amount, MEDPAR beneficiary blood deductible amount; and then subtracting from the sum the MEDPAR DRG outlier approved payment amount. SOURCE: NCH 50. MEDPAR Total Pass Through NUM 8 260 267 The total of all claim pass through amounts (rounded to Amount whole dollars) for the stay. 7 DIGITS SIGNED COMMON ALIAS: BILL_TOTAL_PER_DIEM DB2 ALIAS: PASS_THRU_AMT SAS ALIAS: PASSTHRU STANDARD ALIAS: MEDPAR_PASS_THRU_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by multiplying the 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ pass thru per diem amount that is present on the last claim record included in the stay times the MEDPAR utilization day count (the sum of the utilization (covered) days reported on the claims that comprise the stay). COMMENT: Items reimbursed as pass through include capital-related cos direct medical education costs, kidney acquisition costs for hospitals approved as rtc's, and bad debts (per provider reimbursement manual, part 1, section 2405.2). The MEDPAR pass thru amount is not included in the MEDPAR Medicare payment amount. SOURCE: NCH 51. MEDPAR Total PPS Capital NUM 8 268 275 The total amount (rounded to whole dollars) that is payable Amount for capital PPS (e.g., reimbursement for depreciation, rent, certain interest, real estate taxes for hospital buildings/equipment subject to PPS). 7 DIGITS SIGNED COMMON ALIAS: PPS_CAPITAL DB2 ALIAS: TOT_PPS_CPTL_AMT SAS ALIAS: PPS_CPTL STANDARD ALIAS: MEDPAR_TOT_PPS_CPTL_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the total PPS capital amount that is present on any of the claim records included in the stay (i.e., the sum of total PPS capital amounts reported on the claims that comprise the stay). COMMENT: This field is already included in the MEDPAR Medicare paymen amount. SOURCE: NCH 52. FILLER CHAR 12 276 287 53. MEDPAR Total Charge Amount NUM 8 288 295 The total amount (rounded to whole dollars) of all charges (covered and noncovered) for all services provided to the beneficiary for the stay. 7 DIGITS SIGNED 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ COMMON ALIAS: TOTAL_CHARGES DB2 ALIAS: TOT_CHRG_AMT SAS ALIAS: TOTCHRG STANDARD ALIAS: MEDPAR_TOT_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the total charge amount from all claim records included in the stay (i.e., the sum of total charges reported on the claims that comprise the stay). SOURCE: NCH 54. MEDPAR Total Covered Charge NUM 8 296 303 The portion of the total charges amount (rounded to whole Amount dollars) that is covered by Medicare for the stay. 7 DIGITS SIGNED COMMON ALIAS: COVERED_CHARGES DB2 ALIAS: TOT_CVR_CHRG_AMT SAS ALIAS: CVRCHRG STANDARD ALIAS: MEDPAR_TOT_CVR_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by calculating the covered charges from all claim records included in the stay (i.e., subtract the revenue center noncovered charge amount from the revenue center total charge amount for revenue center code = 0001 that is reported on the claims that comprise the stay; sum the results). Exception: if there exists an erroneous condition relative to revenue center code 0001, the calculation will be made for each revenue center code included on the claims that comprise the stay with the results summed to create the total. SOURCE: NCH 55. MEDPAR Medicare Payment NUM 8 304 311 Amount of payment made from the Medicare trust fund for the Amount services covered by the claim record. Generally, the amount is calculated by the fi; and represents what was paid to the institutional provider, with the exceptions noted below. **Note: in some situations, a negative claim payment amount May be present; e.g., (1) when a beneficiary is charged the full deductible during a short stay and the deductible exceeded the amount Medicare pays; or (2) when a beneficiary is charged a coinsurance amount during a long stay and the 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ coinsurance amount exceeds the amount Medicare pays (most prevalent situation involves psych hospitals who are paid a daily per diem rate no matter what the charges are.) Under ip PPS, Inpatient hospital services are paid based on a predetermined rate per discharge, using the DRG patient classification system and the pricer program. On the ip PPS claim, the payment amount includes the DRG outlier approved payment amount, disproportionate share (since 5/1/86), in- direct medical education (since 10/1/88), total PPS capital (since 10/1/91). It does not include the pass thru amounts (i.e., capital-related costs, direct medical education costs, kidney acquisition costs, bad debts); or any beneficiary-paid amounts (i.e., deductibles and coinsurance); or any other payer remibursement. Under SNF PPS, SNFs will classify beneficiaries using the patient classification system known as rugs III. For the SNF PPS claim, the SNF pricer will calculate/return the rate for each revenue center line item with revenue center code = '0022'; multiply the rate times the units count; and then sum the amount payable for all lines with revenue center code '0022' to determine the total claim payment amount. Exceptions: For claims involving demos and bba encounter data, the amount reported in this field May not just represent the actual provider payment. For demo ids '01','02','03','04' -- claims contain amount paid to the provider, except that special 'differentials' paid outside the normal payment system are not included. For demo ids '05','15' -- encounter data 'claims' contain amount Medicare would have paid under ffs, instead of the actual pay- ment to the MCO. For demo ids '06','07','08' -- claims contain actual provider payment but represent a special negotiated bundled payment for both part a and part B services. To identify what the conventional provider part a payment would have been, check value code = 'y4'. For bba encounter data (non-demo) -- 'claims' contain amount Medicare would have paid under ffs, instead of the actual payment to the bba plan. 7 DIGITS SIGNED COMMON ALIAS: REIMBURSEMENT_AMOUNT DB2 ALIAS: MDCR_PMT_AMT SAS ALIAS: PMT_AMT STANDARD ALIAS: MEDPAR_MDCR_PMT_AMT EDIT-RULES: +$$$$$$$ 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the payment amount that is present on all of the claim records included in the stay (i.e, the sum of payment (reimbursement) reported on the claims that comprise the stay). SOURCE: NCH 56. MEDPAR All Accommodations NUM 8 312 319 The total charge amount (rounded to whole dollars) for all Total Charge Amount accommodations (routine hospital room and board charges for general care, coronary care and/or intensive care units) related to a beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: TOTAL_ACCOMMODATIONS_CHARGES DB2 ALIAS: ACMDTNS_CHRG_AMT SAS ALIAS: ACMDTNS STANDARD ALIAS: MEDPAR_ACMDTNS_TOT_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is the sum of MEDPAR private room charge amount, MEDPAR semiprivate room charge amount, MEDPAR ward charge amount, MEDPAR intensive care charge amount, and MEDPAR coronary care charge amount (i.e., the accumulation of the revenue center total charge amount associated with revenue center codes 0100 - 0219 from all claim records included in the stay). SOURCE: NCH 57. MEDPAR Departmental Total NUM 8 320 327 The total charge amount (rounded to whole dollars) for Charge Amount all ancillary departments (other than routine room and board, CCU, and ICU) related to a beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: TOTAL_DEPARTMENTAL_CHARGES DB2 ALIAS: DPRTMNTL_CHRG_AMT SAS ALIAS: DPRTMNTL STANDARD ALIAS: MEDPAR_DPRTMNTL_TOT_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ total charge amount associated with revenue center codes 0220 - 0999 from all claim records included in the stay (i.e, the sum of charges for all revenue centers other than accommodations 0100 - 0219). SOURCE: NCH **** MEDPAR Accomodations Days GROUP 20 328 347 STANDARD ALIAS: MEDPAR_ACMDTNS_DAYS_GRP Group 58. MEDPAR Private Room Day NUM 4 328 331 The count of the number of private room days used by the Count beneficiary for the stay. 3 DIGITS SIGNED COMMON ALIAS: PRIVATE_ROOM_DAYS DB2 ALIAS: PRVT_ROOM_DAY_CNT SAS ALIAS: PRVTDAY STANDARD ALIAS: MEDPAR_PRVT_ROOM_DAY_CNT DERIVATION: This field is derived by accumulating the revenue center unit count associated with accommodation revenue center codes 011x and 014x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9033-9044 series. SOURCE: NCH 59. MEDPAR Semiprivate Room Day NUM 4 332 335 The count of the number of semi-private room days used by Count the beneficiary for the stay. 3 DIGITS SIGNED COMMON ALIAS: SEMI_PRIVATE_ROOM_DAYS DB2 ALIAS: SEMIPRVT_DAY_CNT SAS ALIAS: SPRVTDAY STANDARD ALIAS: MEDPAR_SEMIPRVT_ROOM_DAY_CNT DERIVATION: This field is derived by accumulating the revenue center unit count associated with accommodation revenue center codes 010X, 012X, 013X, 016X - 019X from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9019-9032 series. SOURCE: NCH 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 60. MEDPAR Ward Day Count NUM 4 336 339 The count of the number of ward days used by the beneficiary for the stay. 3 DIGITS SIGNED COMMON ALIAS: WARD_DAYS DB2 ALIAS: WARD_DAY_CNT SAS ALIAS: WARDDAY STANDARD ALIAS: MEDPAR_WARD_DAY_CNT DERIVATION: This field is derived by accumulating the revenue center unit count associated with accommodation revenue center code 015x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9000-9018 series. SOURCE: NCH 61. MEDPAR Intensive Care Day NUM 4 340 343 The count of the number of intensive care days used by the Count beneficiary for the stay. 3 DIGITS SIGNED COMMON ALIAS: INTENSIVE_CARE_DAYS DB2 ALIAS: INTNSV_CARE_CNT SAS ALIAS: ICARECNT STANDARD ALIAS: MEDPAR_INTNSV_CARE_DAY_CNT DERIVATION: This field is derived by accumulating the revenue center unit count associated with accommodation revenue center codes 020X (all 9 subcategories) from all claims included in the stay. SOURCE: NCH LIMITATIONS: There is approximately a 20% error rate in the revenue center code category 0206 due to coders misunderstanding the term 'post ICU' as including any day after an ICU stay rather than just days in a step-down/lower case version of an ICU. 'Post' was removed from the revenue center code 0206 description, effective 10/1/96 (12/96 MEDPAR update). 0206 Is now defined as 'intermediate ICU'. 62. MEDPAR Coronary Care Day NUM 4 344 347 The count of the number of coronary care days used by the Count beneficiary for the stay. 3 DIGITS SIGNED 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ COMMON ALIAS: CORONARY_CARE_DAYS DB2 ALIAS: CRNRY_CARE_DAY_CNT SAS ALIAS: CRNRYDAY STANDARD ALIAS: MEDPAR_CRNRY_CARE_DAY_CNT DERIVATION: This field is derived by accumulating the revenue center unit count associated with accommodation revenue center code 021x (all six subcategories) from all claim records included in the stay. SOURCE: NCH LIMITATIONS: There is approximately a 20% error rate in the revenue center code category 0214 due to coders misunderstanding the term 'post ccu' as including any day after a ccu stay rather than just days in a step-down/lower case version of a ccu. 'Post' was removed from the revenue center code 0214 description, effective 10/1/96 (12/96 MEDPAR update). 0214 Is now defined as 'intermediate ccu'. **** MEDPAR Accomodations GROUP 40 348 387 STANDARD ALIAS: MEDPAR_ACMDTNS_CHRG_GRP Charges Group 63. MEDPAR Private Room Charge NUM 8 348 355 The charge amount (rounded to whole dollars) for private Amount room accommodations related to a beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: PRIVATE_ROOM_CHARGES DB2 ALIAS: PRVT_ROOM_CHRG_AMT SAS ALIAS: PRVTAMT STANDARD ALIAS: MEDPAR_PRVT_ROOM_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 011x and 014x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9033-9044 series. SOURCE: NCH 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 64. MEDPAR Semi-Private Room NUM 8 356 363 The charge amount (rounded to whole dollars) for semi- Charge Amount private room accommodations related to a beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: SEMI_PRIVATE_ROOM_CHARGES DB2 ALIAS: SEMIPRVT_CHRG_AMT SAS ALIAS: SPRVTAMT STANDARD ALIAS: MEDPAR_SEMIPRVT_ROOM_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 010x, 012x, 013x, and 016x - 019x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9019-9032 series. SOURCE: NCH 65. MEDPAR Ward Charge Amount NUM 8 364 371 The charge amount (rounded to whole dollars) for ward accommodations related to a beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: WARD_CHARGES DB2 ALIAS: WARD_CHRG_AMT SAS ALIAS: WARDAMT STANDARD ALIAS: MEDPAR_WARD_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount amount associated with revenue center code 015x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9000-9018 series. SOURCE: NCH 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ 66. MEDPAR Intensive Care NUM 8 372 379 The charge amount (rounded to whole dollars) for intensive Charge Amount care accommodations related to a beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: INTENSIVE_CARE_CHARGES DB2 ALIAS: INTNSV_CARE_AMT SAS ALIAS: ICAREAMT STANDARD ALIAS: MEDPAR_INTNSV_CARE_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount associated with accommodation revenue center code 020x from all claim records included in the stay. SOURCE: NCH 67. MEDPAR Coronary Care Charge NUM 8 380 387 The charge amount (rounded to whole dollars) for coronary Amount care accommodations related to a beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: CORONARY_CARE_CHARGES DB2 ALIAS: CRNRY_CHRG_AMT SAS ALIAS: CRNRYAMT STANDARD ALIAS: MEDPAR_CRNRY_CARE_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount associated with accommodation revenue center code 021X from all claim records included in the stay. SOURCE: NCH **** MEDPAR Service Charges GROUP 200 388 587 STANDARD ALIAS: MEDPAR_SRVC_CHRG_GRP Group 68. MEDPAR Other Service Charge NUM 8 388 395 The charge amount (rounded to whole dollars) for other Amount services (revenue centers that do not fit into other categories) related to a beneficiary's stay. 7 DIGITS SIGNED 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ COMMON ALIAS: OTHER_CHARGES DB2 ALIAS: OTHR_SRVC_CHRG_AMT SAS ALIAS: OTHRAMT STANDARD ALIAS: MEDPAR_OTHR_SRVC_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount associated with the 'other' revenue center codes from all claim records included in the stay. the 'other' codes include 0002-0099, 022x, 023x, 024x, 052x, 053x, 055x - 060x, 064x - 070x, 076x - 078x, 090x - 095x, and 099x. (Some of these codes are not yet assigned.) SOURCE: NCH 69. MEDPAR Pharmacy Charge NUM 8 396 403 The charge amount (rounded to whole dollars) for Amount pharmaceutical costs related to the beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: PHARMACY_CHARGES DB2 ALIAS: PHRMCY_CHRG_AMT SAS ALIAS: PHRMCAMT STANDARD ALIAS: MEDPAR_PHRMCY_CHRG_AMT EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 025x, 026x, and 063x from all claims records included in the stay. SOURCE: NCH 70. MEDPAR Medical/Surgical NUM 8 404 411 The charge amount (rounded to whole dollars) for Supplies Charge Amount medical/surgical supplies related to the beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: MEDICAL_SUPPLY_CHARGES DB2 ALIAS: MDCL_SUPLY_AMT SAS ALIAS: SUPLYAMT STANDARD ALIAS: MEDPAR_MDCL_SUPLY_CHRG_AMT 1 Medicare Provider Analysis and Review (MEDPAR) Expanded Modified Record -- 06/2003 POSITIONS NAME TYPE LENGTH BEG END CONTENTS --------------------------- ---- ------ --------- ------------------------------------------------------------ EDIT-RULES: +$$$$$$$ ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES DERIVATION: This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 027x and 062x from all claim records included in the stay. SOURCE: NCH 71. MEDPAR DME Charge Amount NUM 8 412 419 The charge amount (rounded to whole dollars) for DME (purchase of new DME and rentals) related to the beneficiary's stay. 7 DIGITS SIGNED COMMON ALIAS: DME_CHARGES