Ask the Payment Expert about ... Medicare data

Patricia Boyer,  MSM, NHA, RN
Patricia Boyer, MSM, NHA, RN

It seems like Medicare always has so much information about us. How can we access that data? 

Medicare does compile information from the claims (UB-04s) you submit for payment. In March, the Centers for Medicare & Medicaid Services released a new dataset about each facility through the Skilled Nursing Facility Utilization and Payment Public Use File.

This information was for claims received in calendar year 2013. CMS has developed files that evaluate information in different ways. The files include five tables: 1) aggregated information by provider, 2) aggregated information by provider and RUG, 3) aggregated information by RUG, 4) aggregated information by RUG and state, and 5) aggregated information on therapy minutes by provider. 

Table 1 allows you to see your specific facility information including average length of stay, total Medicare charges you submitted that were allowed, and payment amounts after deductible and coinsurance. For Table 2, information includes provider information by RUG level. Table 3 will show you information by RUG level but does not have facility specific information. Table 4 has information by state by RUG level but no facility specific information. Finally, Table 5 gives you facility-specific information for RU and RV, including numerator and denominator counts, as well as identifying your percentage of RU and RV that were provided within 10% of the threshold. 

You can access data at www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/SNF.html . Additional files are at www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-03-09.html.

It is important that you know how CMS is evaluating your facility.