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Examples of Optional Claims Screens
Developed by Part B Carriers

9. Suspend pay for second office visit (procedures 90015 and 90060) in 1 month for same diagnosis.

10. Allow one office consultation (procedures 90600 through 90620) per month for same diagnosis. Reduce additional claims in the same month to procedure 90640.

Appendix V

Contents of Selected Medicare Statistical Files

Inpatient Hospital and
Skilled Nursing
Facility Bill Record

The discussion below and accompanying tables describe the data included in the HCFA Medicare files summarized in chapter 5. For each data element listed for each Medicare file, we have indicated, where appropriate, information that could be used to describe individual patient characteristics or the structure, process, or outcomes of care.

Table V.1 contains billing and demographic information on beneficiary
hospital stays and skilled nursing facility treatment episodes. Since
1983, this file has also contained information on principal diagnosis and
surgical procedures for all hospital stays. Prior to October 1983, diagno-
sis and procedure information was assembled for a 20-percent sample of
Medicare admissions. As bills are cleared by HCFA and the health insur-
ance master file is updated, the enrollee's demographic characteristics
are added to the bill information. All bills submitted for the same hospi-
tal stay are sorted and summarized to create a bill summary record.
When the bill summary indicates that the patient has been discharged, a
stay record showing information from date of admission to date of dis-
charge is created. In approximately 95 percent of the cases, the entire
stay is on a single bill.

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Inpatient stay file content

17. HMO effective date

18. HMO termination date

19. HMO number

20. HMO option code

21. Bill covers period

a. From date

b. Through date

22. Query code

23. Transaction code

24. Adjustment code
25. SPIDER indicatora
26. Employment related
27. Provider number
28. Special unit code

29. Intermediary number
30. Date approved

31. Date forwarded

32. Date of admission

33. Patient status code

34. Discharge date

35. Date of death

36. Total covered days

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37. Cost report days

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Inpatient stay file content

51. Blood pints furnished

52. Blood pints replaced
53. Blood pints not replaced

54. Blood charge per pint

55 Total blood charges

56 Total blood noncovered charges

57. Noncovered from date

58. Noncovered through date

59. Open item from date

60. Open item through date

61. Nonpayment code

62. Total charges

63. Reimbursement amount

64. Diagnostic data

a. Number of diagnostic codes

b. Principal diagnosis code

c. Additional diagnosis

65. Surgery data

a. Number of surgery codes

b. Principal surgery

c. Additional surgery

d. Date of surgery

66. Noncovered charges

67. End-stage renal disease indicator

68. Qualifying dates

a. From date

b. To date

69. DRG number

70. Discharge destination

71. DRG outlier code

72. Date guarantee of payment began

73. Date utilization review notice received

74. Date active care ended

75. Date benefits exhausted

76. Outlier amount

77. HMO paid/readmission indicator

78. KRON indicatorb

79. Value code

80. Value code amount

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aThe system to provide immediate data on eligibility for reimbursement (SPIDER) is a HCFA data system under development.

bProvides information about the bill's Medicare spell-of-illness status.

Medicare Provider
Analysis and Review
File

The Medicare provider analysis and review file is derived from the inpatient hospital stay record and the provider of services file. Characteristics of the provider are added to selected fields from the hospital stay record. The file is prepared every 3 months and contains 3 years of discharges (the current year and 2 previous years). Table V.2 illustrates this file.

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