Hospital Outpatient Beneficiary Payments

This variable is contained in the following files:

Master Beneficiary Summary File (MBSF): Cost and Use Segment

SAS Name

HOP_BENE_PMT

This variable is the sum of Medicare coinsurance and deductible payments in the hospital outpatient (HOP) setting for a given year. The total beneficiary payment is calculated as the sum of the beneficiary deductible amount and coinsurance amount (variables called REV_CNTR_CASH_DDCTBLE_AMT and REV_CNTR_COINSRNC_WGE_ADJSTD_C) for all HOP claims where the CLM_PMT_AMT >= 0.

Comments

Costs that beneficiaries are liable for are described in detail on the Medicare.gov 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: 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)