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The data in this column indicates the date of the last attempt to do a gradual dose reduction (GDR) of antipsychotic medication.
The data in this column indicates whether a physician has documented a gradual dose reduction (GDR) as clinically contraindicated.
The data in this column indicates the date a physician documented a gradual dose reduction (GDR) as clinically contraindicated.
The data in this column indicates whether a complete drug regimen review identified potential clinically significant medication issues.
Indicates the facility contacted a physician (or physician-designee) by midnight of the next calendar day and completed prescribed/ recommended actions in response to the identified potential clinically significant medication issues.
The data in this column indicates whether the facility contacted the physician (or physician-designee) by midnight the next calendar day and completed the prescribed/recommended actions in response to the identified potential clinically significant medication issues.
The data in this column indicates whether the facility contacted and completed the physician (or physician-designee) prescribed/ recommended actions by midnight of the next calendar day each time potential clinically significant medication issues were identified since the admission.
The facility’s name.
Name of practice
Name of provider associated with the NPI as recorded in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS)
Legal Business Name Associated with the ACO Participant TIN.
A code in National Drug Code (NDC) format indicating the drug, device, or medical supply covered by this claim.
NATIONAL DRUG CODE (NDC) FOR THIS SERVICE.
Indicates that the Part D plan benefit package is a stand-alone Prescription Drug Plan (PDP) offered by a national Part D sponsor.
Mandated by HIPAA as a unique provider number assigned for each health care provider to be used in standard electronic health care transactions. Effective August 2008.
NATIONAL PROVIDER IDENTIFIER OF THE INSTITUTION BILLING/CARING FOR THE ENROLLEE.
National Provider Identifier of a supplier associated with ACO participants in one of the following ways: (1) reassigned billing rights to an ACO participant during the performance period, based on information in the Medicare Provider Enrollment, Chain, and Ownership System (PECOS); (2) identified by PECOS as a sole proprietor using an ACO participant TIN that has not reassigned its billing rights; or (3) appeared as rendering services on a claim submitted by an ACO participant TIN during the performance period.
The date on a claim for which the covered level of care ended in a general hospital or the active care ended in a psychiatric/tuberculosis hospital.
The amount of money for which the intermediary determined the beneficiary is liable for the blood deductible.
A blood deductible amount applies to the first 3 pints of blood (or equivalent units; applies only to whole blood or packed red cells - not platelets, fibrinogen, plasma, etc. which are considered biologicals). However, blood processing is not subject to a deductible. Calculation of the deductible amount considers both Part A and Part B claims combined. The blood deductible does not count toward meeting the inpatient hospital deductible or any other applicable deductible and coinsurance amounts for which the patient is responsible.
On an inpatient or Home Health claim, the date the beneficiary was discharged from the facility, or died.
Date matches the "thru" date on the claim (CLM_THRU_DT) unless the beneficiary is still a patient (i.e., this field is not populated if discharge status code [PTNT_DSCHRG_STUS_CD]= 30 [still a patient]). When there is a discharge date, the PTNT_DSCHRG_STUS_CD indicates the final disposition of the patient after discharge.
The amount of the deductible the beneficiary paid for inpatient services, as originally submitted on the institutional claim.
Under Part A, the deductible applies only to inpatient hospital care (whether in an acute care facility, Inpatient psychiatric facility [IPF], inpatient rehabilitation facility [IRF], or long term care hospital [LTCH]) and is charged only at the beginning of each benefit period, which is similar to an episode of illness.
This variable is null/missing for skilled nursing facility (SNF), home health, and hospice claims.
The last date for which the beneficiary has Medicare coverage.
This is completed only where benefits were exhausted before the date of discharge and during the billing period covered by this institutional claim.
The amount of money for which the intermediary has determined that the beneficiary is liable for Part A coinsurance on the institutional claim.
Under Part A, beneficiaries pay coinsurance starting with the 61st day of an inpatient hospital stay (one daily amount for days 61-90, and a higher daily amount for any days after that, which count towards a beneficiary’s 60 lifetime reserve days) or the 21st day of a skilled nursing facility (SNF) stay (a daily amount for days 21-100, after which SNF coverage ends).
This variable is null/missing for home health and hospice claims.
The amount of money for which the intermediary has determined that the beneficiary is liable for Part B coinsurance on the institutional claim.
The amount of money for which the intermediary or carrier has determined that the beneficiary is liable for the Part B cash deductible on the claim.
Number of whole pints of blood furnished to the beneficiary, as reported on the carrier claim (non-DMERC).
The total allowed charges on the claim (the sum of line item allowed charges).
The total submitted charges on the claim (sum of all line-level submitted charges, variable called LINE_SBMTD_CHRG_AMT)
The total payments made to the beneficiary for this claim (sum of all line-level payments to beneficiary, variable called LINE_BENE_PMT_AMT).
The total payments made to the provider for this claim (sum of line item provider payment amounts (variable called LINE_PRVDR_PMT_AMT).
The type of claim that was submitted. There are different claim types for each major category of health care provider.
On an institutional claim, the additional payment amount approved by the Quality Improvement Organization due to an outlier situation for a beneficiary's stay under the prospective payment system (PPS), which has been classified into a specific diagnosis related group (DRG).
This variable will typically include the total outlier payment amount, if any, for the claim.
The non-covered charges for all accommodations and services, reported on an inpatient claim (used for internal NCHMQA editing purposes).
The total of all Part A and blood deductibles and coinsurance amounts on the claim.
A code defining the type of claim record being processed.
This variable is a recoded version of the discharge status code (variable called PTNT_DSCHRG_STUS_CD).
The amount of a payment made on behalf of a Medicare beneficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges on a non-institutional claim.
The code, on an institutional claim, specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's health insurance bills.
The presence of a primary payer code indicates that some other payer besides Medicare covered at least some portion of the charges.
The two-digit numeric social security administration (SSA) state code where provider or facility is located.
The two-digit numeric social security administration (SSA) state code where provider or facility is located.
The beginning date of the beneficiary's qualifying Medicare stay.
For inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization of benefits.
For SNF claims, the date relates to a qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'A' (transfer from critical access hospital), or at least three days in a row if the source of admission is other than 'A'.
The ending date of the beneficiary's qualifying Medicare stay.
For inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization of benefits.
For SNF claims, the date relates to a qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'A' (transfer from critical access hospital), or at least three days in a row if the source of admission is other than 'A'.
The beginning date of the beneficiary's Non-covered stay.
Medicare places limits on the number of days of inpatient or SNF care that a beneficiary may receive.
For some beneficiaries, all days in one of these settings may not be covered by Medicare.
The ending date of the beneficiary's non-covered stay.
Medicare places limits on the number of days of inpatient or SNF care that a beneficiary may receive.
For some beneficiaries, all days in one of these settings may not be covered by Medicare.
The date the weekly NCH database load process cycle begins, during which the claim records are loaded into the Nearline file. This date will always be a Friday, although the claims will actually be appended to the database subsequent to the date.
This is the unique identification number assigned by the National Council for Prescription Drug Programs (NCPDP) to every licensed pharmacy in the United States and its territories.
This field also enables linkage between pharmacies in the Part D Event (PDE) File and the CCW Pharmacy Characteristics File for 2014+.
This is the unique, national identification number assigned by the National Council for Prescription Drug Programs (NCPDP) to every licensed pharmacy in the United States and its territories.
This field also enables linkage between pharmacies in the Part D Event (PDE) File and the CCW Pharmacy Characteristics File.
The maximum allowable quantity of a drug or service that may be dispensed per prescription per date of service or per month.