Acute Inpatient Medicare Covered Days

SAS Name
ACUTE_COV_DAYS

This variable is the count of Medicare covered days in the acute inpatient hospital setting for the year. This variable equals the sum of the CLM_UTLZTN_DAY_CNT variables on the source claims.

Comments

Acute inpatient hospital 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.

We consider fully-covered days, days where the beneficiary was liable for coinsurance, and lifetime reserve days to all be Medicare-covered days. Non-covered days, leave of absence days, and the day of discharge or death are not included. There are 2 cost/use categories from the IP data files: Acute and the OIP.

Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics” (see: http://www.medpac.gov/-documents-/payment-basics).

Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series” (see the list of MLN publications at: http://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNProducts/MLN- Publications.html)

Source: CCW (derived)

Null/missing or 1-XXX.