All information in
this report is taken from the Medicare Outpatient Prospective
Payment System (OPPS)
Limited Data Set which is updated annually by
based on the
calendar year. The file includes billing data for 100% of
all Medicare fee-for-service claims for hospital outpatient
services during the
twelve months ending December 31. The report is based on
the most recent period available and is consistent with
cell size suppression policy.
defined based on the revenue code for a line item.
Averages are based on units of service (i.e. the number of units
of items or services delivered).
Patient Claims - the total number of claims for the service.
- Units of
Service - the number of units of the items or services
delivered. (One claim may have multiple units of
service for an item or service.)
Charge - the total charges (covered and non-covered) for all
accommodations and services (related to the revenue code)
for a billing period before reduction for the deductible and
coinsurance amounts and before an adjustment for the cost of
Cost - Charges adjusted to cost using the hospital's
specific cost center cost-to-charge ratio.
This calculation is done by CMS and included with OPPS claims data. (Details of the calculation are not provided by CMS.)
Payment - The computed OPPS payment for a line item based on
the payment APC. The "payment APC" refers to total payment,
including deductible, coinsurance, and program payment.
Mix Index (SMI) - Each APC has a relative weight assigned by
CMS. The Service Mix Index is the average relative weight of
the procedures billed for a service (e.g. the average
relative weight of all surgical procedures performed).