Skilled Nursing Facility Beneficiary Payments

This variable is contained in the following files:

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

SAS Name

SNF_BENE_PMT

This variable is the sum of Medicare coinsurance and deductible payments in the skilled nursing facility (SNF) setting for the year. The total beneficiary payment is calculated as the sum of the beneficiary deductible amount and coinsurance amount (variables called NCH_BENE_IP_DDCTBL_AMT and NCH_BENE_PTA_COINSRNC_LBLTY_AM) for all SNF 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)