Reminder: DUA and VRDC access needs to be extended or renewed annually. Read more.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Acquired Hypothyroidism.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for acquired hypothyroidism on July 1 of the specified reference period.
Active Diagnosis Comorbidities and Co-existing Conditions - Diabetes Mellitus
Active Diagnosis Comorbidities and Co-existing Conditions - Peripheral Vascular Disease (PVD) or Peripheral Arterial Disease (PAD)
Active practice or inactive practice.
The quantity of a drug, service, or product that is rendered/dispensed for a prescription, on a specific date of service, or billing time span.
This variable is the sum of Medicare coinsurance and deductible payments in the acute inpatient hospital setting for the year. The total acute hospitalization beneficiary payments are 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 acute inpatient claims where the CLM_PMT_AMT >= 0.
This variable is the sum of all the pass through per diem payment amounts (CLM_PASS_THRU_PER_DIEM_AMT from each claim) in the acute inpatient hospital setting for the year. Medicare payments are designed to include certain "pass-through" expenses such as capital- related costs, direct medical education costs, kidney acquisition costs for hospitals that are renal transplant centers, and bad debts. This variable is the sum of all the daily payments for pass-through expenses. It is not included in the Medicare Payment amount (ACUTE_MDCR_PMT). To determine the total Medicare payments for acute hospitalizations for the beneficiary, this field must be added to the total Medicare payment amount for acute inpatient hospitalizations.
This variable indicates the total amount paid for acute inpatient hospital stays by a primary payer other than Medicare. It is the sum of all the primary payer amounts (NCH_PRMRY_PYR_CLM_PD_AMT from each claim) in the acute inpatient hospital setting for the year.
This variable is the count of hospital readmissions in the acute inpatient setting for a given year.
The CLM_FROM_DT for the original admission must have been in the year of the data file, however it was permissible for the readmission claim to have occurred in January of the following year. A beneficiary is considered to be readmitted when they have an acute inpatient stay with a discharge status that is not expired (DSCHRG_STUS=20) or left against medical advice (DSCHRG_STUS not equal to 07) within 30 days of a previous acute inpatient stay with a discharge status that is also not expired or left against medical advice.
This variable is the count of Medicare covered days in the acute inpatient hospital setting for the year. This variable equals the sum of the CLM_UTLZTN_DAY_CNT variables on the source claims.
This variable is the sum of the Medicare claim payment amounts (CLM_PMT_AMT from each claim) in the acute inpatient hospital setting for a given year. To obtain the total acute hospital Medicare payments, take this variable and add in the annual per diem payment amount (ACUTE_MDCR_PMT + ACUTE_PERDIEM_AMT).
This variable is the count of acute inpatient hospital stays (unique admissions, which may span more than one facility) for the year. An acute inpatient stay is defined as a set of one or more consecutive acute inpatient hospital claims where the beneficiary is only discharged on the most recent claim in the set. If a beneficiary is transferred to a different provider, the acute stay is continued even if there is a discharge date on the claim from which the beneficiary was transferred.
This variable indicates whether a beneficiary met the Chronic Conditions Warehouse (CCW) criteria for an acute myocardial infarction (AMI; heart attack) as of the end of the calendar year.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for an acute myocardial infarction (AMI; heart attack) as of the end of the calendar year.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having an Acute Myocardial Infarction.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having Acute Myocardial Infarction.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having Acute Myocardial Infarction.
This variable indicates whether a beneficiary met the Chronic Condition Data Warehouse (CCW) criteria for an acute myocardial infarction (AMI; heart attack) on July 1 of the specified reference period.
This variable indicates whether a beneficiary met the condition criteria for attention deficit hyperactivity disorder (ADHD) or other conduct disorders as of the end of the calendar year.
This variable indicates whether a beneficiary met the condition criteria for attention deficit hyperactivity disorder (ADHD) or other conduct disorders as of the end of the calendar year.NOTE: The condition variable requires beneficiaries to satisfy both claims criteria (a minimum number/type of Medicare claims that have the proper diagnosis codes and occurred within a specified time period) and coverage criteria (Medicare FFS Part A and Part B coverage during the entire specified time period).NOTE1: For ADHD and other conduct disorders, beneficiaries must have at least one Medicare inpatient claim or two other non-drug claims of any service type with a related code in any position during the 2-year reference period. You can find more detailed information on the criteria on the CCW website: https://www.ccwdata.org/web/guest/condition-categories
This variable shows the date when the beneficiary first met the criteria for the attention deficit hyperactivity disorder (ADHD) or other conduct disorders indicator. The variable will be blank for beneficiaries that have never had the condition.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering both Medicare and Medicaid data, for having ADHD and Other Conduct Disorders.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicaid data, for having ADHD and Other Conduct Disorders.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having ADHD and Other Conduct Disorders.
This code specifies whether the enrollee met the chronic condition algorithm criteria, considering only Medicare data, for having attention deficit hyperactivity disorder (ADHD) or other conduct disorders as of the end of the calendar year.
'ADI is determined based on most recent available data within the Shared Savings Program ACO report period. A small number of beneficiaries will not receive ADI because of address changes or census block groups. These beneficiaries will receive an imputed ADI National Percentile Rank of 50.
The date on which the state made the final adjudication on the payment status of the claim.
A unique claim number assigned by the state’s payment system that identifies the adjustment claim for an original transaction
A unique number to identify the transaction line number that is being reported on the adjustment internal control number (ICN).
CODE INDICATING IF THE CLAIMS FOR THIS SERVICE WERE ONLY ORIGINAL SUBMISSIONS, INCLUDED ADJUSTEMENTS OF ANY TYPE OR IF ONE OR MORE ORIGINAL SUBMISSIONS WAS MISSING.
This field distinguishes original from adjusted or deleted PDE records so CMS can adjust claims and make accurate payment for revised PDE records.
Claim adjustment reason codes communicate why a claim was paid differently than it was billed.
DATE WHICH THE RECIPIENT WAS ADMITTED FOR THIS INPATIENT STAY.
The date on which the recipient was admitted to a hospital.
The time (hour) of admission to the hospita
The basic types of admission for Inpatient hospital stays and a code indicating the priority of this admission.
Assessment type of patient
The ICD-9/10-CM Diagnosis Code provided at the time of admission by the physician.
The variable identifies the coding system used for the admitting diagnosis code
The state-assigned provider identifier for the doctor responsible for admitting a patient to a hospital or other inpatient health facility
The National Provider ID (NPI) of the doctor responsible for admitting a patient to a hospital or other inpatient health facility.
This code describes the area of specialty for the admitting provider.
The taxonomy code for the admitting provider.
A code describing the type of admitting provider.
Advanced Care Directives Section Notes
A code to identify the category of program with which the provider is affiliated.
Patient Age
Beneficiary age in years during the last month of enrollment in the calendar year.
The beneficiary’s age in years on the date of admission