Demonstration number

SAS Name
DEMO_ID_NUM

The number assigned to identify a CMS demonstration project.

This field is also used to denote special processing (a.k.a. Special Processing Number, SPN).

Comments

Source: NCH

Code Code value
01 Nursing Home Case-Mix and Quality: NHCMQ (RUGS) Demo – testing PPS for SNFs in 6 states, using a case-mix classification system based on resident characteristics and actual resources used. The claims carry a RUGS indicator and one or more revenue center codes in the 9,000 series.
02 National HHA Prospective Payment Demo -- testing PPS for HHAs in 5 states, using two alternate methods of paying HHAs: per visit by type of HHA visit and per episode of HH care.
03 Telemedicine Demo -- testing covering traditionally non-covered physician services for medical consultation furnished via two-way, interactive video systems (i.e. teleconsultation)in 4 states. The claims contain line items with 'QQ' HCPCS code.
04 United Mine Workers of America (UMWA) Managed Care Demo -- testing risk sharing for Part A services, paying special capitation rates for all UMWA beneficiaries residing in 13 designated counties in 3 states. Under the demo, UMWA will waive the 3-day qualifying hospital stay for a SNF admission. The claims contain TOB '18X','21X','28X' and '51X'; condition code = W0; claim MCO paid switch = not '0'; and MCO contract # = '90091'.
05 Medicare Choices (MCO encounter data) demo --testing expanding the type of Managed Care plans available and different payment methods at 16 MCOs in 9 states. The claims contain one of the specific MCO Plan Contract # assigned to the Choices Demo site. NOTE - this demonstration was terminated 12/31/2000.
06 Coronary Artery Bypass Graft (CABG) Demo --testing bundled payment (all-inclusive global pricing) for hospital + physician services related to CABG surgery in 7 hospitals in 7 states. The inpatient claims contain a DRG '106' or '107'. NOTE - this demonstration was terminated in 1998.
07 Virginia Cardiac Surgery Initiative (VCSI) (formerly referred to as Medicare Quality Partnerships Demo) -- this is a voluntary consortium of the cardiac surgery physician groups and the non-Veterans Administration hospitals providing open heart surgical services in the Commonwealth of Virginia. The goal of the demo is to share data on quality and process innovations in an attempt to improve the care for all cardiac patients. The demonstration only affects those FIs that process claims from hospitals in Virginia and the carriers that process claims from physicians providing inpatient services at those hospitals. The hospitals will be reimbursed on a global payment basis for selected cardiac surgical diagnosis related groups (DRGs). The inpatient claims will contain a DRG '104', '105', '106', '107', '109'; the related physician/supplier claims will contain the claim payment denial reason code = 'D'. NOTE - The implementation date for this demonstration is 4/1/03.
08 Provider Partnership Demo -- testing per-case payment approaches for acute inpatient hospitalizations, making a lump-sum payment (combining the normal Part A PPS payment with the Part B allowed charges into a single fee schedule) to a Physician/Hospital Organization for all Part A and Part B services associated with a hospital admission. From 3 to 6 hospitals in the Northeast and Mid-Atlantic regions may participate in the demo.
15 ESRD Managed Care (MCO encounter data) -- testing open enrollment of ESRD beneficiaries and capitation rates adjusted for patient treatment needs at 3 MCOs in 3 States. The claims contain one of the specific MCO Plan Contract # assigned to the ESRD demo site.
30 Lung Volume Reduction Surgery (LVRS) or National Emphysema Treatment Trial (NETT) Clinical Study -- evaluating the effectiveness of LVRS and maximum medical therapy (including pulmonary rehab) for Medicare beneficiaries in last stages of emphysema at 18 hospitals nationally, in collaboration with NIH.
31 VA Pricing Special Processing (SPN) -- not really a demo but special request from VA due to court settlement; not Medicare services but VA inpatient and physician services submitted to FI 00400 and Carrier 00900 to obtain Medicare pricing -- NCH WILL PROCESS VA CLAIMS ANNOTATED WITH DEMO ID '31', BUT WILL NOT TRANSMIT TO HCFA (CMS) (not in Nearline File).
37 Medicare Coordinated Care Demonstration -- to test whether coordinated care services furnished to certain beneficiaries improves outcome of care and reduces Medicare expenditures under Part A and Part B. There will be at least 14 Coordinated Care Entities (CCEs). The selected entities will be assigned a provider number specifically for the demonstration services.
37 Medicare Disease Management (DMD) -- the purpose of this demonstration is to study the impact on costs and health outcomes of applying disease management services supplemented with coverage for prescription drugs for certain Medicare diagnosed, beneficiaries with advanced-stage congestive heart failure, diabetes, or coronary heart disease. Three demonstration sites will be used for this demonstration and it will last for 3 years. (Effective 4/1/2003).
38 Physician Encounter Claims - the purpose of this demo id is to identify the physician encounter claims being processed at the HCFA Data Center (HDC). This number will help EDS in making the claim go through the appropriate processing logic, which differs from that for fee-for-service. **NOT IN NCH.** NOTE - Effective October, 2000. Demo ids will not be assigned to Inpatient and Outpatient encounter claims.
39 Centralized Billing of Flu and PPV Claims -- The purpose of this demo is to facilitate the processing carrier, Trailblazers, paying flu and PPV claims based on payment localities. Providers will be giving the shots throughout the country and transmitting the claims to Trailblazers for processing. NOTE - Effective October, 2000 for carrier claims.
40 Payment of Physician and Non-physician Services in certain Indian Providers -- the purpose of this demo is to extend payment for services of physician and non-physician practitioners furnished in hospitals and ambulatory care clinics. Prior to the legislation change in BIPA, reimbursement for Medicare services provided in IHS facilities was limited to services provided in hospitals and skilled nursing facilities. This change will allow payment for IHS, Tribe and Tribal Organization providers under the Medicare physician fee schedule. NOTE - Effective July 1, 2001 for institutional and carrier claims.
45 Chiropractic
48 Medical Adult Day-Care Services -- the purpose of this demonstration is to provide, as part of the episode of care for home health services, medical adult day care services to Medicare beneficiaries as a substitute for a portion of home health services that would otherwise be provided in the beneficiaries home. This demo would last approx. 3 years in not more than 5 sites. Payment for each home health service episode of care will be set at 95% of the amount that would otherwise be paid for home health services provided entirely in the home. NOTE - Effective July 5, 2005 for HHA claims.
49 Hemodialysis
53 Extended Stay
54 ACE Demo
56 ACA 3113 Lab Demo
58 used to identify the Multi-payer Advanced Primary Care Practice (MAPCP) demonstration. (eff. 7/2/12)
59 ACO Pioneer Demonstration (eff. 1/2014)
60 PMD (Power Motorized Vehicle)
61 CLM-CARE-IMPRVMT-MODEL-1
62 CLM-CARE-IMPRVMT-MODEL-2
63 CLM-CARE-IMPRVMT-MODEL-3
64 CLM-CARE-IMPRVMT-MODEL-4
65 rebilled claims due to auditor denials -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
66 rebilled claims due to provider self-audit after claim submission/payment -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
67 rebilled claims due to provider self-audit after the patient has been discharged, but prior to payment -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
68 NCH will not apply the 3-day hospital stay requirement when processing a SNF claim. (eff. 1/2014)
70 used for Electrical Workers Insurance Fund claims. (eff. 7/2/12)
71 IVIG (Intravenous Immunoglobulin)
74 unknown value
77 Shared Savings Program (eff. 10/2016)
78 Comprehensive Primary Care Plus (CPC+) (eff. 4/2017)
79 Acute Myocardial Infarction (AMI) Episode Payment Model (EPM) (eff. 1/2018)
80 Coronary Artery Bypass Graft (CABG) Episode Payment Model (EPM) (eff. 1/2018)
81 Surgical Hip and Femur Fracture Treatment (SHFFT) Episode Payment Model (EMP) (eff. 1/2018)
82 Medicare Diabetes Prevention Program (MDPP) (eff. 4/2018)
83 Maryland Primary Care Program (MDPCP) (eff. 1/2018)