Updated research request forms and data security approval requirement effective 4/24/23
This variable is contained in the following files:
SAS Name
OIP_MDCR_PMT
This variable is the sum of the Medicare claim payment amounts (CLM_PMT_AMT from each claim) in the other inpatient (OIP) settings for a given year. To obtain the total OIP Medicare payments, take this variable and add in the annual per diem payment amount (OIP_MDCR_PMT + OIP_PERDIEM_AMT).
These OIP claims are a subset of the claims in the IP data file consisting of data from IP settings such as long- term care hospitals, inpatient psychiatric facilities, inpatient rehabilitation facilities, and other types of IP facilities such as children’s hospitals or cancer centers.
There are 2 cost/use categories from the IP data files: Acute and the OIP.
OIP_PERDIEM_PMT must be added to this field to obtain the total Medicare payments. The annual per diem variable was new in 2010; it will always be null/missing in earlier files.
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)