{"identifier":"bfa315c5-a2f2-4b69-a4ff-65f5f0b30cf9","data":{"title":"Medicare PAC Utilization - SNF by Geography\/Provider and CMG Data Dictionary 2014 - 2019","fields":[{"name":"YEAR","label":"Year","description":"The year of data."},{"name":"YEAR_TYPE","label":"Year Type","description":"Identifies if the data is for calendar year (CY) or fiscal year (FY)."},{"name":"SMRY_CTGRY","label":"Summary Category","description":"Identifies if the data is at the national, state, or provider level."},{"name":"SRVC_CTGRY","label":"Service Category","description":"Identifies the PAC setting: HH, hospice, SNF, IRF, or LTCH."},{"name":"STATE","label":"State","description":"The state where the provider is located, as reported in Provider of Services file. The fifty U.S. states, the District of Columbia, and Puerto Rico are reported by their postal abbreviation. Note for national level, no state is reported."},{"name":"PRVDR_ID","label":"Provider ID","description":"The 6-digit CCN for the provider."},{"name":"PRVDR_NAME","label":"Facility Name","description":"The provider name, as reported in the Provider of Services file."},{"name":"PRVDR_CITY","label":"City","description":"The city where the provider is located, as reported in the Provider of Services file."},{"name":"PRVDR_ZIP","label":"ZIP","description":"The provider\u2019s ZIP code, as reported in the Provider of Services file Note, for state and national levels, ZIP code is not reported."},{"name":"GRPNG","label":"Grouping","description":"This is the 3-character RUG."},{"name":"GRPNG_DESC","label":"Grouping Description","description":"Description of the 3-character RUG."},{"name":"BENE_DSTNCT_CNT","label":"Distinct Beneficiaries","description":"Number of unique Medicare beneficiaries with at least one paid claim in the calendar or fiscal year."},{"name":"TOT_EPSD_STAY_CNT","label":"Episode or Stay Count","description":"The total counts of stays provided in the fiscal year."},{"name":"TOT_SRVC_DAYS","label":"Days of Service","description":"Total count of covered days delivered by a provider in the CY."},{"name":"AVG_CHRG_PER_BENE","label":"Average Charge Per Beneficiary","description":"Average of the Total Charge Amount per beneficiary. The Total Charge Amount is the total charges submitted by the provider."},{"name":"AVG_ALOWD_AMT_PER_BENE","label":"Average Allowed Amount Per Beneficiary","description":"Average of the Medicare Allowed Amount per beneficiary.  The Medicare Allowed Amount is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. This applies only to the IRF Provider by CMG supplemental file."},{"name":"AVG_PYMT_AMT_PER_BENE","label":"Average Payment Amount Per Beneficiary","description":"Average of the Total Medicare Payment Amount per beneficiary.  The Total Medicare Payment Amount is the total amount that Medicare paid after deductible and coinsurance amounts have been deducted."},{"name":"AVG_STDZD_PYMT_AMT_PER_BENE","label":"Average Standardized Payment Amount Per Beneficiary","description":"Average of the Total Medicare Standardized Payment Amount per beneficiary.  The Medicare Standardized Payment Amount is the total amount that Medicare paid adjusted for geographic differences in payment rates."},{"name":"AVG_CHRG_PER_STAY","label":"Average Charge Per Stay","description":"Average of the Total Charge Amount per Stay. The Total Charge Amount is the total charges submitted by the provider."},{"name":"AVG_ALOWD_AMT_PER_STAY","label":"Average Allowed Amount Per Stay","description":"Average of the Medicare Allowed Amount per Stay.  Typically, the Medicare Allowed Amount is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying."},{"name":"AVG_PYMT_AMT_PER_STAY","label":"Average Payment Amount Per Stay","description":"Average of the Total Medicare Payment Amount per Stay.  The Total Medicare Payment Amount is the total amount that Medicare paid after deductible and coinsurance amounts have been deducted."},{"name":"AVG_STDZD_PYMT_AMT_PER_STAY","label":"Average Standardized Payment Amount Per Stay","description":"Average of the Total Medicare Standardized Payment Amount per Stay.  The Medicare Standardized Payment Amount is the total amount that Medicare paid adjusted for geographic differences in payment rates."},{"name":"AVG_CHRG_PER_DAY","label":"Average Charge Per Day","description":"Average of the Total Charge Amount per Day. The Total Charge Amount is the total charges submitted by the provider."},{"name":"AVG_ALOWD_AMT_PER_DAY","label":"Average Allowed Amount Per Day","description":"Average of the Medicare Allowed Amount per Day.  Typically, the Medicare Allowed Amount is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying."},{"name":"AVG_PYMT_AMT_PER_DAY","label":"Average Payment Amount Per Day","description":"Average of the Total Medicare Payment Amount per Day.  The Total Medicare Payment Amount is the total amount that Medicare paid after deductible and coinsurance amounts have been deducted."},{"name":"AVG_STDZD_PYMT_AMT_PER_DAY","label":"Average Standardized Payment Amount Per Day","description":"Average of the Total Medicare Standardized Payment Amount per Day.  The Medicare Standardized Payment Amount is the total amount that Medicare paid adjusted for geographic differences in payment rates."},{"name":"CASEMIX","label":"Casemix Grouping","description":"Casemix Grouping associated with a SNF RUG.  Groupings include: (a) Default (DEFAULT), (b) Low, Medium, or High Rehabilitation (REHAB), (c) Very-High Rehabilitation (VERY_HIGH_REHAB), (d) Ultra-High Rehabilitation (ULTRA_HIGH_REHAB), (e) Clinically Complex (CLNCL_CMPLX), (f) Reduced Physical Functioning (RDCD_PHYS_FNCTNG), (f) Special High Care (SPCL_HIGH_CARE), (g) Behavioral Symptom (BHVRL_SMPTM), and (h) Extensive Service (EXTNSV_SRVC_DAYS). The Default RUG grouping consists of the AAA RUG code, which is the default RUG rate, and is generally used when the SNF does not submit the MDS assessment in accordance with the prescribed assessment schedule. The Low, Medium, or High Rehabilitation RUGs include RUG Codes RLA, RLB, RLX, RMA, RMB, RMC, RML, RMX, RHA, RHB, RHC, RHL, and RHX. Residents in RL, RM, and RH RUGs meet therapy thresholds of 45, 150, and 325 minutes per week, respectively. The Very-High Rehabilitation RUGs include RUG codes RVA, RVB, RVC, RVL, and RVX.  Residents in RV RUGs meet a therapy threshold of 500 minutes per week. The Ultra-High Rehabilitation RUGs include RUG codes RUA, RUB, RUC, RUL, and RUX. Residents in RU RUGs meet a therapy threshold of 720 minutes per week. The Clinically Complex RUGs include RUG codes CA1, CA2, CB1, CB2, CC1, CC2, CD1, CD2, CE1, and CE2. Residents in clinically complex RUGs may generally include those with burns, coma, septicemia, pneumonia, foot\/wounds, internal bleeding, dehydration, tube feeding, oxygen, transfusions, hemiplegia, chemotherapy, dialysis, those with higher numbers of physician visits and order changes, and those with diabetes, 7 day injection, and higher numbers of order changes. The Reduced Physical Functioning RUGs include RUG codes PA1, PA2, PB1, PB2, PC1, PC2, PD1, PD2, PE1, and PE2. Residents in reduced physical functioning RUGs may generally require nursing rehabilitation activities at least six days a week, including passive or active ROM, amputation care, splint care, or training in dressing or grooming, eating or swallowing, transfer, bed mobility or walking, communication, scheduled toileting program or bladder retraining. The Special High Care RUGs include RUG codes HB1, HB2, HC1, HC2, HD1, HD2, HE1, and HE2. Residents in special high care RUGs are generally those with high number of limitations in their activities of daily living (ADLs) and multiple sclerosis, quadriplegia or cerebral palsy, seven days of respiratory therapy, a stage 3 or 4 pressure ulcer or multiple pressure ulcers of any stage, surgical wounds or open lesions, radiation, tube feeding and aphasia, fever with dehydration, pneumonia, vomiting, weight loss, or tube feeding. The Behavioral Symptom RUGs include RUG codes BA1, BA2, BB1, and BB2. Residents in behavioral symptom RUGs are generally those who exhibit wandering, physical or verbal abuse, inappropriate behavior or resisting care, or hallucinations or delusions four or more day a week. The Extensive Service RUGs include RUG codes ES1, ES2, and ES3. Residents in extensive service RUGs are generally those with some (but not high) limitations in the number of activities of daily living (ADLs) and in need of the following services: intravenous feeding or medications, suctioning, tracheostomy care, or ventilator\/respirator use."},{"name":"CASEMIX_DAY_PCT","label":"Percent (%) of Days in a SNF RUG Grouping","description":"Percent of total paid Medicare days which were delivered under a particular RUG casemix grouping. See CASEMIX for descriptions of the RUG groupings."}]}}