Acute Inpatient Hospital Beneficiary Payments

SAS Name

This variable is the sum of Medicare coinsurance and deductible payments in the acute inpatient hospital setting for the year. The total acute hospitalization beneficiary payments are calculated as the sum of the beneficiary deductible amount and coinsurance amount (variables called NCH_BENE_IP_DDCTBL_AMT and NCH_BENE_PTA_COINSRNC_LBLTY_AM) for all acute inpatient claims where the CLM_PMT_AMT >= 0.


Acute inpatient claims are a subset of the claims in the IP data file consisting of data from both acute hospitals and critical access hospitals (CAH). These facilities are those where either the 3rd digit of the provider number (SAS variable PRVDR_NUM) = 0 or the 3rd and 4th digits of PRVDR_NUM = 13.

There are 2 cost/use categories from the IP data files: Acute and OIP.

Costs that beneficiaries are liable for are described in detail on the website. There is a CMS publication called "Your Medicare Benefits", which explains the deductibles and coinsurance amounts.

Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics” (see:

Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series” (see the list of MLN publications at: Publications.html)

Source: CCW (derived)