Hospital Outpatient Beneficiary Payments

This variable is contained in the following files:

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”.

Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series”.

Source: CCW (derived)