Inpatient Charge Data FY 2011
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.
Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service. 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, average total payments, 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.
Fields
The following fields are available on the Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) API.
- DRG Definition
Type: text
Code and description identifying the DRG. DRG Definitions are a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay.
- Provider Id
Type: number
Provider Identifier billing for inpatient hospital services.
- Provider Name
Type: text
Name of the provider.
- Provider Street Address
Type: text
Street address in which the provider is physically located.
- Provider City
Type: text
City in which the provider is physically located.
- Provider State
Type: text
A state in which the provider is physically located.
- Provider Zip Code
Type: number
Zip code in which the provider is physically located.
- Hospital Referral Region Description
Type: text
HRR in which the provider is physically located.
- Total Discharges
Type: number
The number of discharges billed by the provider for inpatient hospital services.
- Average Covered Charges
Type: money
The provider's average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
- Average Total Payments
Type: money
The average total payments to all providers for the DRG including the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
- Average Medicare Payment
Type: money
The average amount that Medicare pays to the provider for Medicare's share of the MS-DRG. Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits.