**** PROVIDER SPECIFIC RECORD REC 240 1 240 THE PROVIDER SPECIFIC FILE IS DEVELOPED BY THE

INTERMEDIARIES FOR USE IN THE HOSPITAL PROSPECTIVE

PAYMENT SYSTEM (PPS) 'PRICER' SUBROUTINE. A

REIMBURSEMENT PRICE IS COMPUTED FOR AN INDIVIDUAL

INPATIENT HOSPITAL STAY DEPENDING ON THE DIAGNOSIS

RELATED GROUP (DRG) IN WHICH THE STAY IS CLASSIFIED.

THE PROVIDER SPECIFIC FILE IS USED IN CENTRAL OFFICE

TO SUPPORT DRG RECALIBRATION; ITS COMPLETENESS IS

MEASURED BY COMPARISON TO THE PROVIDER OF SERVICE

FILE AND THE MEDPAR FILE.

SYSTEM ALIAS: PRVDRSP

1. PROVIDER NUMBER CHAR 6 1 6 THE IDENTIFICATION NUMBER OF THE INSTITUTIONAL

PROVIDER CERTIFIED BY MEDICARE TO PROVIDE SERVICES

TO THE BENEFICIARY.

STANDARD ALIAS: PRVDR_NUM

SAS ALIAS: PROVIDER

TITLE ALIAS: PROVIDER_NUMBER

CODES:

- FIRST TWO POSITIONS ARE THE STATE CODE.

CODING SCHEME:

REFER TO SSA_STD_STATE_TB

- POSITIONS 3 AND SOMETIMES 4 ARE USED AS A

CATEGORY IDENTIFIER. THE REMAINING POSITIONS

ARE SERIAL NUMBERS. THE FOLLOWING BLOCKS OF NUMBERS

ARE RESERVED FOR THE FACILITIES INDICATED:

0001-0899 SHORT-TERM (GENERAL AND SPECIALTY)

HOSPITALS

0900-0999 MULTIPLE HOSPITAL COMPONENT IN A

MEDICAL COMPLEX (NUMBERS RETIRED)

1000-1199 RESERVED FOR FUTURE USE

1200-1224 ALCOHOL/DRUG HOSPITALS (EXCLUDED

FROM PPS-NUMBERS RETIRED)

1225-1299 MEDICAL ASSISTANCE FACILITIES

(MONTANA PROJECT)

1300-1399 RURAL PRIMARY CARE HOSPITAL (RPCH)

1400-1499 RESERVED FOR FUTURE USE

1500-1799 HOSPICES

1800-1899 FEDERALLY QUALIFIED HEALTH CENTERS

(FQHC)

1900-1989 RESERVED FOR FUTURE USE

1990-1999 CHRISTIAN SCIENCE SANATORIA

(HOSPITAL SERVICES)

2000-2299 LONG-TERM HOSPITALS (EXCLUDED FROM PPS)

2300-2499 CHRONIC RENAL DISEASE FACILITIES

(HOSPITAL BASED)

2500-2899 NON-HOSPITAL RENAL DISEASE

TREATMENT CENTERS

2900-2999 INDEPENDENT SPECIAL PURPOSE RENAL

DIALYSIS FACILITY (1)

3000-3024 FORMERLY TUBERCULOSIS HOSPITALS

(NUMBERS RETIRED)

3025-3099 REHABILITATION HOSPITALS (EXCLUDED

FROM PPS)

3100-3299 RESERVED FOR FUTURE USE

3300-3399 CHILDREN'S HOSPITALS (EXCLUDED FROM PPS)

3400-3499 CONTINUATION OF RURAL HEALTH CLINICS

(PROVIDER-BASED) (3975-3999)

3500-3699 RENAL DISEASE TREATMENT CENTERS

(HOSPITAL SATELLITES)

3700-3799 HOSPITAL BASED SPECIAL PURPOSE RENAL

DIALYSIS FACILITY (1)

3800-3974 RURAL HEALTH CLINICS (FREE-STANDING)

3975-3999 RURAL HEALTH CLINICS (PROVIDER-BASED)

4000-4499 PSYCHIATRIC HOSPITALS (EXCLUDED

FROM PPS)

4500-4599 COMPREHENSIVE OUTPATIENT

REHABILITATION FACILITIES (CORF)

4600-4799 COMMUNITY MENTAL HEALTH CENTERS (CMHC)

4800-4899 CONTINUATION OF 4500-4599 SERIES (CORF)

4900-4999 CONTINUATION OF 4600-4799 SERIES (CMHC)

5000-6399 SKILLED NURSING FACILITIES

6400-6499 RESERVED FOR FUTURE USE (2)

6500-6989 OUTPATIENT PHYSICAL THERAPY SERVICES

6990-6999 CHRISTIAN SCIENCE SANATORIA (SKILLED

NURSING SERVICES)

7000-7299 HOME HEALTH AGENCIES (3)

7300-7399 SUBUNITS OF 'NONPROFIT' AND

'PROPRIETARY' HOME HEALTH AGENCIES (4)

7400-7799 CONTINUATION OF 7000-7299 SERIES

7800-7999 SUBUNITS OF STATE AND LOCAL GOVERNMENTAL

HOME HEALTH AGENCIES (4)

8000-8499 CONTINUATION OF 7400-7799 SERIES

8500-8899 CONTINUATION OF RURAL HEALTH

CENTER (PROVIDER BASED) (3400-3499)

8900-8999 CONTINUATION OF RURAL HEALTH

CENTER (FREE-STANDING) (3800-3975)

9000-9799 CONTINUATION OF 8000-8499 SERIES

EXCEPTION:

P001-P999 ORGAN PROCUREMENT ORGANIZATION

(1) THESE FACILITIES (SPRDFS) WILL BE ASSIGNED

THE SAME PROVIDER NUMBER WHENEVER THEY

ARE RECERTIFIED.

(2) THE 6400-6499 SERIES OF PROVIDER NUMBERS

IN IOWA (16), SOUTH DAKOTA (43) AND TEXAS (45)

HAVE BEEN USED IN REDUCING ACUTE CARE COSTS (RACC)

EXPERIMENTS.

(3) IN VIRGINIA (49), THE SERIES 7100-7299 HAS

BEEN RESERVED FOR STATEWIDE SUBUNIT COMPONENTS

OF THE VIRGINIA STATE HOME HEALTH AGENCIES.

(4) PARENT AGENCY MUST HAVE A NUMBER IN THE

7000-7299, 7400-7799 OR 8000-8499 SERIES.

NOTE:

THERE IS A SPECIAL NUMBERING SYSTEM FOR UNITS

OF HOSPITALS THAT ARE EXCLUDED FROM PROSPECTIVE

PAYMENT SYSTEM (PPS) AND HOSPITALS WITH SNF

SWING-BED DESIGNATION. AN ALPHA CHARACTER IN

THE THIRD POSITION OF THE PROVIDER NUMBER

IDENTIFIES THE TYPE OF UNIT OR SWING-BED

DESIGNATION AS FOLLOWS:

S = PSYCHIATRIC UNIT (EXCLUDED FROM PPS)

T = REHABILITATION UNIT (EXCLUDED FROM PPS)

U = SHORT TERM/ACUTE CARE SWING-BED HOSPITAL

V = ALCOHOL DRUG UNIT (PRIOR TO 10/87 ONLY)

W = LONG TERM SNF SWING-BED HOSPITAL

(EFF 3/91)

Y = REHAB HOSPITAL SWING-BED (EFF 9/92)

Z = RURAL PRIMARY CARE SWING-BED HOSPITAL

(TO BE EFFECTIVE IN 1994)

THERE IS ALSO A SPECIAL NUMBERING SYSTEM FOR

ASSIGNING EMERGENCY HOSPITAL IDENTIFICATION

NUMBERS (NON PARTICIPATING HOSPITALS). THE

SIXTH POSITION OF THE PROVIDER NUMBER IS AS

FOLLOWS:

E = NON-FEDERAL EMERGENCY HOSPITAL

F = FEDERAL EMERGENCY HOSPITAL

SQL-INFO:

CHAR(6) NOT NULL

SOURCE:

OSCAR

2. EFFECTIVE DATE NUM 6 7 12 THIS IS THE EFFECTIVE DATE OF THE DATA ON THE RECORD OR THE

DATE OF THE LATEST CHANGE IN ANY FIELD ON THIS RECORD.

6 DIGITS

EDIT-RULES:

YYMMDD

YY MUST BE GREATER THAN 82 BUT NOT GREATER

THAN THE CURRENT YEAR

SOURCE:

THE INTERMEDIARY

3. WAIVER INDICATOR CHAR 1 13 13 THIS FIELD SHOWS WHETHER THE PROVIDER HAS RECEIVED A

WAIVER EXEMPTING IT FROM THE PROVISIONS OF PPS.

CODES:

N = NOT WAIVED (UNDER PPS)

Y = WAIVED (NOT UNDER PPS)

SOURCE:

THE INTERMEDIARY

4. PROVIDER TYPE CHAR 2 14 15 THE PROVIDER TYPE FIELD IDENTIFIES THE TYPE OF FACILITY

RELATIVE TO ITS STATUS AS A FULLY OR PARTIALLY PPS-EXEMPT

FACILITY OR AS A FACILITY RECEIVING SPECIAL TREATMENT UNDER

CODES:

00 = SHORT-TERM FACILITY (MAY ALSO BE LEFT BLANK)

01 = SOLE COMMUNITY PROVIDER

02 = LONG TERM

03 = PSYCHIATRIC

04 = REHABILITATION FACILITY

05 = PEDIATRIC

06 = HOSPITAL DISTINCT PARTS

07 = RURAL REFERRAL CENTER

08 = INDIAN HEALTH SERVICE

09 = REDESIGNATED RURAL - YEAR 1

10 = REDESIGNATED RURAL - YEAR 2

11 = SOLE COMMUNITY/REFERRAL CENTER PROVIDER

13 = CANCER PROVIDER FACILITY

14 = MEDICARE DEPENDENT HOSPITAL (EFFECTIVE 4/1/90)

15 = MEDICARE DEPENDENT HOSPITAL/REFERRAL CENTER

16 = REBASED SOLE COMMUNITY HOSPITAL

17 = REBASED SOLE COMMUNITY HOSPITAL/REFERRAL CENTER

18 = MEDICAL ASSISTANCE FACILITY

SOURCE:

THE INTERMEDIARY

5. CURRENT CENSUS DIVISION NUM 1 16 16 THIS IS THE CENSUS DIVISION TO WHICH THE FACILITY BELONGS

FOR PAYMENT PURPOSES.

1 DIGIT

CODES:

1 = NEW ENGLAND

2 = MIDDLE ATLANTIC

3 = SOUTH

4 = EAST NORTH CENTRAL

5 = EAST SOUTH CENTRAL

6 = WEST NORTH CENTRAL

7 = WEST SOUTH CENTRAL

8 = MOUNTAIN

9 = PACIFIC

SOURCE:

THE INTERMEDIARY

6. PROVIDER PPS BLEND PERIOD NUM 1 17 17 THIS CODE IS USED TO ASSIGN A SPECIFIC PPS PERIOD

TO A HOSPITAL THAT IS CHANGING TO THE PPS. OVER A

PERIOD OF TIME, IT REPRESENTS THE PPS TRANSITIONAL

PERIOD FOR THE HOSPITAL BASED ON ITS FISCAL YEAR. IN

THE BEGINNING OF THE BLEND PERIOD, THE MAJORITY OF

THE BILLS SUBMITTED BY THE HOSPITAL WOULD NOT BE UNDER

THE PPS BUT WOULD BE ACTUAL BILLS. AS THE BLEND

PERIOD PROGRESSES, THE RATIO REVERSES UNTIL ALL BILLS

WOULD BE UNDER PPS.

1 DIGIT

EDIT-RULES:

BLANK - NOT APPLICABLE

RANGE: 0 THROUGH 9

DO NOT UPDATE THIS FIELD FOR PERIODS ON OR AFTER 4/1/91

SOURCE:

THE INTERMEDIARY

7. ACTUAL GEOGRAPHIC LOCATION CHAR 4 18 21 THE MSA REPRESENTING THE ACTUAL GEOGRAPHIC LOCATION

- METROPOLITAN STATISTICAL WHERE THE FACILITY IS PHYSICALLY LOCATED. AN MSA IS

AREA (MSA) A GEOGRAPHICAL AREA DEFINED FOR STATISTICAL PURPOSES.

THESE ARE FOUND IN A LIST OF MSA'S PUBLISHED BY THE

EXECUTIVE OFFICE OF MANAGEMENT AND BUDGET AND

ADJUSTED BY CONGRESSIONAL MANDATE.

EDIT-RULES:

RANGE: 0040 TO 9360

__99 = RURAL AREA, WHERE __ IS BLANK AND 99 IS STATE

CODE WHERE FACILITY IS PHYSICALLY LOCATED

SOURCE:

THE INTERMEDIARY

8. FISCAL YEAR END NUM 6 22 27 ON THE FIRST RECORD FOR EACH PROVIDER, THIS IS THE

FISCAL YEAR END OF ITS LAST YEAR BEFORE PPS. PPS BILLS

WILL BE ACCEPTED FOR DATES AFTER THIS DATE. FOR

SUBSEQUENT PROVIDER RECORDS, THIS ONLY CHANGES IF THE

PROVIDER CHANGES ITS FISCAL YEAR END (E.G., A CHANGE

OF OWNERSHIP).

6 DIGITS

EDIT-RULES:

MMDDYY

YY - GREATER THAN 82, BUT NOT MORE THAN 1 YEAR

GREATER THAN THE CURRENT YEAR

SOURCE:

THE INTERMEDIARY

9. CASE MIX ADJUSTED COST PER NUM 7 28 34 FOR PPS HOSPITALS AND WAIVER STATE NON-EXCLUDED HOSPITALS,

DISCHARGE THIS IS THE PPS BASE YEAR COST PER DISCHARGE DIVIDED BY

THE CASE MIX INDEX. FOR EXCLUDED HOSPITALS, THIS IS THE

COST PER DISCHARGE FOR THE PRECEDING COST REPORTING PERIOD

SHOWN IN ITEM 8.

5.2 DIGITS

EDIT-RULES:

$$$$$.$$

0 = NEW PROVIDERS

SOURCE:

THE INTERMEDIARY

10. COST OF LIVING ADJUSTMENT NUM 4 35 38 THIS FIELD REFLECTS THE COST OF LIVING ADJUSTMENTS.

THE COST OF LIVING ADJUSTMENTS ARE UPDATED PERIODICALLY.

1.3 DIGITS

CODES:

AREA FY 84 FY 85 FY 86 FY 87-92

(10/1/84- (5/1/86- (10/1/86-

4/30/86) 9/30/86) 9/30/92)

ALASKA 1.250 1.250 1.250 1.250

OAHU 1.200 1.225 1.225 1.225

KAUAI 1.175 1.150 1.150 1.175

MAUI 1.200 1.200 1.200 1.200

MOLAKAI 1.200 1.200 1.200 1.200

LANAI 1.200 1.200 1.200 1.200

HAWAII 1.100 1.125 1.125 1.150

ALL OTHER 1.000 1.000 1.000 1.000

SOURCE:

THE INTERMEDIARY

11. INTERN / BED RATIO NUM 5 39 43 FOR PPS HOSPITALS, THIS FIELD IS A RATIO OF THE

NUMBER OF FULL TIME EQUIVALENT OF INTERNS AND RESIDENTS

DIVIDED BY THE NUMBER OF AVAILABLE BEDS. THIS IS USED TO

CALCULATE THE INDIRECT MEDICAL EDUCATION PAYMENT AMOUNT

(AN ADDITIONAL PAYMENT TO TEACHING HOSPITALS).

1.4 DIGITS

CODES:

0 = NON-TEACHING HOSPITAL

SOURCE:

THE INTERMEDIARY

12. SPECIAL PROVIDER UPDATE NUM 6 44 49 FOR HOSPITALS WITH COST REPORT PERIODS REPRESENTING

FACTOR (PRUP) MORE OR LESS THAN ONE YEAR, THE STANDARD SET OF

UPDATE FACTORS USED TO CALCULATE THE HOSPITAL-

SPECIFIC PORTION OF THE PPS PAYMENT CANNOT BE USED.

THE INTERMEDIARY MUST CALCULATE A SPECIAL UPDATE

FACTOR BASED ON THE HOSPITAL'S COST REPORTING

PERIOD. THIS AMOUNT BECOMES THE PRUP, USED

PRIOR TO FISCAL YEAR 92 ONLY FOR HOSPITALS THAT

HAVE SPECIAL UPDATE FACTORS BECAUSE THEIR BASE

PERIOD ENDED PRIOR TO SEPTEMBER 30, 1982.

1.5 DIGITS

CODES:

0 = NON-PRUP HOSPITAL; ALL HOSPITALS AFTER FY 91

SOURCE:

THE INTERMEDIARY

13. HOSPITAL BEDS NUM 5 50 54 THIS FIELD INDICATES THE NUMBER OF ADULT AND PEDIATRIC

BEDS AVAILABLE FOR USE BY PATIENTS AT THE BEGINNING OF

THE COST REPORTING PERIOD. A BED MEANS AN ADULT BED,

PEDIATRIC BED, OR NEWBORN BED MAINTAINED IN A PATIENT

CARE AREA FOR PATIENTS IN ACUTE, LONG TERM, OR

DOMICILIARY AREAS OF THE HOSPITAL.

5 DIGITS

SOURCE:

THE INTERMEDIARY

14. OPERATING DISPROPORTIONATE NUM 4 55 58 THIS FIELD IS USED TO DISTINGUISH HOSPITALS RECEIVING

SHARE PERCENTAGE (DSH) ADDITIONAL PAYMENTS FOR SERVING A DISPROPORTIONATE

SHARE OF LOW INCOME PATIENTS. THE FIELD IS A

PERCENTAGE 'ADD-ON' TO THE REGULAR PPS PAYMENT. IT

IS DERIVED FROM THE NUMBER OF SUPPLEMENTAL SECURITY

INCOME (SSI) PATIENT DAYS (PATIENT DAYS ARE

CALCULATED BY A FORMULA BASED ON THE NUMBER OF DAYS

SSI AND MEDICAID PATIENTS RECEIVED HOSPITAL SERVICES).

0.4 DIGITS

SOURCE:

THE INTERMEDIARY

15. OPERATING COST TO CHARGE NUM 4 59 62 THIS FIELD IS DERIVED FROM THE LATEST SETTLED COST

RATIO REPORT AND CORRESPONDING CHARGE DATA FROM THE

BILLING FILE. THIS AMOUNT IS COMPUTED BY DIVIDING

THE MEDICARE OPERATING COST (FROM THE COST REPORT)

BY THE MEDICARE COVERED CHARGE (FROM THE BILLING

FILE, I.E., THE PS&R RECORD). FOR HOSPITALS THAT

ARE UNABLE TO COMPUTE A REASONABLE COST-TO-CHARGE

RATIO, THE APPROPRIATE URBAN OR RURAL STATEWIDE

AVERAGE COST-TO-CHARGE RATIO CALCULATED ANNUALLY

BY HCFA IS USED.

1.3 DIGITS

SOURCE:

THE INTERMEDIARY

16. CASE MIX INDEX NUM 5 63 67 HCFA HAS CALCULATED AND PUBLISHED A CASE MIX INDEX

FOR EACH HOSPITAL BASED ON 1981 COST AND BILLING DATA

REFLECTING THE RELATIVE COSTLINESS OF THAT HOSPITAL'S

MIX OF CASES COMPARED TO THE NATIONAL AVERAGE.

1.4 DIGITS

SOURCE:

THE INTERMEDIARY

17. FILLER CHAR 1 68 68 STANDARD ALIAS: FILLER

SAS ALIAS: FILLER

18. REPORT DATE NUM 6 69 74 THIS CODE DENOTES THE DATE THE FILE WAS CREATED.

6 DIGITS

EDIT-RULES:

MMDDYY

SOURCE:

THE INTERMEDIARY

19. FILLER CHAR 1 75 75 STANDARD ALIAS: FILLER

SAS ALIAS: FILLER

20. INTERMEDIARY NUMBER CHAR 5 76 80 THIS FIELD SPECIFIES THE IDENTIFYING NUMBER

OF THE INTERMEDIARY PROCESSING THE BILL.

EDIT-RULES:

FOR THE FIRST TWO POSITIONS:

00 = BLUE CROSS

NN = COMMERCIAL PLAN

SOURCE:

FROM THE FISCAL INTERMEDIARY

21. FISCAL YEAR BEGINNING DATE NUM 6 81 86 THE BEGINNING DATE OF THE PROVIDER'S FISCAL YEAR.

6 DIGITS

EDIT-RULES:

MMDDYY

YY = GREATER THAN 81 BUT NOT GREATER THAN

THE CURRENT YEAR

SOURCE:

THE INTERMEDIARY

22. PASS-THRU AMOUNT FOR NUM 6 87 92 THIS FIELD SHOWS THE PER DIEM (DAILY AVERAGE)

CAPITAL OF MEDICARE CAPITAL AND CAPITAL-RELATED COSTS FOR

INPATIENT ROUTINE AND ANCILLARY SERVICES.

4.2 DIGITS

EDIT-RULES:

$$$$.$$

SOURCE:

THE INTERMEDIARY

23. PASS-THRU AMOUNT FOR DIRECT NUM 6 93 98 THIS FIELD SHOWS THE PER DIEM (DAILY AVERAGE) MEDICARE

MEDICAL EDUCATION DIRECT MEDICAL EDUCATION COST FOR INPATIENT ROUTINE AND

ANCILLARY SERVICES.

4.2 DIGITS

EDIT-RULES:

$$$$.$$

SOURCE:

THE INTERMEDIARY

24. PASS-THRU AMOUNT FOR ORGAN NUM 6 99 104 THIS FIELD IS AN AVERAGE COST PER ORGAN ACQUISITION DERIVED

ACQUISITION FROM THE COST OF ALL ORGANS TRANSPLANTED DURING THE YEAR.

IT INCLUDES ROUTINE AND ANCILLARY SERVICES AND ANY PURCHASE

COSTS RELATIVE TO THE ACQUISITION.

4.2 DIGITS

EDIT-RULES:

$$$$.$$

SOURCE:

THE INTERMEDIARY

25. TOTAL PASS-THRU AMOUNT, NUM 6 105 110 THIS FIELD IS A TOTAL OF OTHER PASS-THRU AMOUNTS INCLUDING

INCLUDING MISCELLANEOUS MISCELLANEOUS AMOUNTS. IT IS A PER DIEM AMOUNT BASED ON THE

INTERIM PAYMENTS TO THE HOSPITAL. IT MUST BE AT LEAST EQUAL

TO THE SUM OF THE THREE PASS-THRU AMOUNTS LISTED PREVIOUSLY,

BUT CAN BE GREATER THAN THIS SUM.

4.2 DIGITS

EDIT-RULES:

$$$$.$$

SOURCE:

THE INTERMEDIARY

26. SUPPLEMENTAL SECURITY NUM 4 111 114 THIS FIELD DENOTES THE SSI RATIO USED TO DETERMINE

INCOME (SSI) RATIO IF THE HOSPITAL QUALIFIES FOR THE DISPROPORTIONATE

SHARE ADJUSTMENT.

0.4 DIGITS

SOURCE:

THE INTERMEDIARY

27. MEDICAID RATIO NUM 4 115 118 THIS FIELD DENOTES THE MEDICAID RATIO USED TO

DETERMINE WHETHER THE HOSPITAL QUALIFIES FOR THE

DISPROPORTIONATE SHARE ADJUSTMENT.

0.4 DIGITS

SOURCE:

THE INTERMEDIARY

28. TERMINATION DATE CHAR 6 119 124 THIS FIELD DENOTES THE DATE ON WHICH THE REPORTING

INTERMEDIARY CEASED SERVICING THE PROVIDER IN

QUESTION.

EDIT-RULES:

YYMMDD

0, BLANK = NO TERMINATION DATE

SOURCE:

THE INTERMEDIARY

29. WAGE INDEX LOCATION - CHAR 4 125 128 THE MSA REPRESENTING THE WAGE INDEX LOCATION TO WHICH

METROPOLITAN STATISTICAL A HOSPITAL HAS BEEN RECLASSIFIED DUE TO ITS PREVAILING

AREA (MSA) WAGE RATES. AN MSA IS A GEOGRAPHICAL AREA DEFINED FOR

STATISTICAL PURPOSES. THESE ARE FOUND IN A LIST OF

MSA'S PUBLISHED BY THE EXECUTIVE OFFICE OF MANAGEMENT

AND BUDGET AND ADJUSTED BY CONGRESSIONAL MANDATE.

EDIT-RULES:

RANGE: 0040 TO 9360

__99 = RURAL AREA, WHERE __ IS BLANK AND 99 IS STATE CODE

WHERE FACILITY IS PHYSICALLY LOCATED

SOURCE:

THE INTERMEDIARY

30. CHANGE CODE FOR WAGE INDEX CHAR 1 129 129 EDIT-RULES:

RECLASSIFICATION ADJUST ANNUALLY

CODES:

Y = HOSPITAL'S WAGE INDEX HAS BEEN RECLASSIFIED

FOR THE YEAR

N = HOSPITAL'S WAGE INDEX HAS NOT BEEN RECLASSIFIED

FOR THE YEAR

31. STANDARDIZED AMOUNT CHAR 4 130 133 THE MSA REPRESENTING THE WAGE INDEX LOCATION TO WHICH

LOCATION - METROPOLITAN A HOSPITAL HAS BEEN RECLASSIFIED. AN MSA IS A

STATISTICAL AREA (MSA) GEOGRAPHICAL AREA DEFINED FOR STATISTICAL PURPOSES.

THESE ARE FOUND IN A LIST OF MSA'S PUBLISHED BY THE

EXECUTIVE OFFICE OF MANAGEMENT AND BUDGET AND

ADJUSTED BY CONGRESSIONAL MANDATE.

EDIT-RULES:

RANGE: 0040 TO 9360

__99 = RURAL AREA, WHERE __ IS BLANK AND 99 IS STATE CODE

WHERE FACILITY IS PHYSICALLY LOCATED

SOURCE:

THE INTERMEDIARY

32. SOLE COMMUNITY OR MEDICARE CHAR 2 134 135 CODES:

DEPENDENT HOSPITAL BASE BLANK = NOT A SOLE COMMUNITY OR MEDICARE DEPENDENT

YEAR HOSPITAL

82 = 1982 IS BASE YEAR FOR THE OPERATING HOSPITAL

SPECIFIC RATE

87 = 1987 IS BASE YEAR FOR THE OPERATING HOSPITAL

SPECIFIC RATE

33. FILLER CHAR 25 136 160

34. CAPITAL PPS PAYMENT CODE CHAR 1 161 161 CODE SPECIFYING THE TYPE OF CAPITAL PAYMENT METHODOLOGY

CODES:

A = HOLD HARMLESS - COST PAYMENT FOR OLD CAPITAL

B = HOLD HARMLESS - 100% FEDERAL RATE

C = FULLY PROSPECTIVE BLENDED RATE

BLANK = NEW HOSPITAL WITHIN FIRST 2 YEARS OF OPERATION

35. HOSPITAL SPECIFIC CAPITAL NUM 6 162 167 HOSPITAL'S ALLOWABLE ADJUSTED BASE YEAR INPATIENT

RATE CAPITAL COSTS PER DISCHARGE.

4.2 DIGITS

EDIT-RULES:

NUMERIC; UPDATE ANNUALLY

36. OLD CAPITAL HOLD HARMLESS NUM 6 168 173 HOSPITAL'S ALLOWABLE INPATIENT 'OLD' CAPITAL COSTS

RATE PER DISCHARGE INCURRED FOR ASSETS ACQUIRED BEFORE

DECEMBER 31, 1990, FOR CAPITAL PPS.

4.2 DIGITS

EDIT-RULES:

NUMERIC; UPDATE ANNUALLY

37. NEW CAPITAL - HOLD HARMLESS NUM 5 174 178 RATIO OF HOSPITAL'S ALLOWABLE INPATIENT COSTS FOR NEW

RATIO CAPITAL TO THE HOSPITAL'S TOTAL ALLOWABLE INPATIENT

CAPITAL COSTS.

1.4 DIGITS

EDIT-RULES:

NUMERIC; UPDATE ANNUALLY

38. CAPITAL COST TO CHARGE NUM 4 179 182 DERIVED FROM THE LATEST COST REPORT AND CORRESPONDING

RATIO CHARGE DATA FROM THE BILLING FILE. WHERE A REASONABLE

COST TO CHARGE RATIO CANNOT BE COMPUTED FOR A HOSPITAL,

THE APPROPRIATE STATEWIDE AVERAGE COST TO CHARGE RATIO

(CALCULATED ANNUALLY BY HCFA) IS USED.

1.3 DIGITS

39. NEW HOSPITAL INDICATOR CHAR 1 183 183 CODES:

Y = HOSPITAL IS WITHIN FIRST TWO YEARS OF OPERATION

BLANK = DEFAULT

40. CAPITAL INDIRECT MEDICAL NUM 5 184 188 THE RATIO OF RESIDENTS/INTERNS TO THE HOSPITAL'S

EDUCATION RATIO AVERAGE DAILY CENSUS.

1.4 DIGITS

CODES:

ZEROS = NON-TEACHING HOSPITAL

41. CAPITAL EXCEPTION PAYMENT NUM 6 189 194 THE PER DISCHARGE EXCEPTION PAYMENT TO WHICH A

RATE HOSPITAL IS ENTITLED.

4.2 DIGITS

42. FILLER CHAR 46 195 240