A provider level summary of Outpatient Prospective Payment System (OPPS) average estimated submitted charges and average Medicare Payments for 30 selected Ambulatory Payment Classification (APC) Groups.
9/04/2013 UPDATE: As a result of using the OPPS ratesetting process to develop the summary of outpatient charge and payment data, we inadvertently excluded claims data for visit APCs 0604 (“Level 1 Hospital Clinic Visits”) and 0607 (“Level 4 Hospital Clinic Visits”). The revised outpatient data reflects changes to correct this, with volume increases in the summarized data for APCs 0604 and 0607.
A provider level summary of Outpatient Prospective Payment System (OPPS) average estimated submitted charges and average Medicare Payments for 30 selected Ambulatory Payment Classification (APC) Groups.
6/2/14 UPDATE: Original FY2011 data file has been updated to include a new column, "Average Medicare Payment." 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 Fiscal Year (FY) 2011. These DRGs represent more than 7 million discharges or 60 percent of total Medicare IPPS discharges.
For more information, see https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2011.html.
The data provided here include estimated hospital-specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2012. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
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 Fiscal Year (FY) 2012. These DRGs represent more than 7 million discharges or 60 percent of total Medicare IPPS discharges.
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 Fiscal Year (FY) 2013. These DRGs represent more than 7 million discharges or 60 percent of total Medicare IPPS discharges.
The Inpatient Utilization and Payment Public Use File (Inpatient PUF) provides information on inpatient discharges for Medicare fee-for-service beneficiaries. The Inpatient PUF includes information on utilization, payment (total payment and Medicare payment), and hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments. The PUF is organized by hospital and Medicare Severity Diagnosis Related Group (MS-DRG) and covers Fiscal Year (FY) 2015. MS-DRGs included in the PUF represent more than 7 million discharges or 75 percent of total Medicare IPPS discharges.
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 discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2014. These MS-DRGs represent more than 7 million discharges or 75 percent of total Medicare IPPS discharges.
