_dta: 1. psfinp set up by Jean Roth , jroth@nber.org , 18 Feb 2018 2. Source Page: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/LongTermCareHospitalPPS/LTCHP > PS-Regulations-and-Notices-Items/CMS1184306.html 3. Source File URL: www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/Downloads/I > NP-PSF.zip 4. Source Text File: INP_psf9710.txt 5. Addendum A - Provider Specific File 6. (Rev. 817, Issued: 01-20-06, Effective: 04-01-06, Implementation: 04-03-06) 7. 20 78-80 X(3) Filler Blank. 8. 51 219-240 X(22) Filler Blank. provider: 1. Provider Number 2. 2 11-16 X(6) Provider Oscar Alpha-numeric 6 character provider 3. No. number. Cross check to provider type. 4. Positions 3 and 4 of: 5. Provider # Provider Type 6. 00-08 Blanks, 00, 07-11, 7. 13-17, 21-22 8. 12 18 9. 13 23,37 10. 20-22 02 11. 30 04 12. 33 05 13. 40-44 03 14. 50-64 32-34, 38 15. 15-17 35 16. 70-84, 90-99 36 17. Codes for special units are in the third 18. position of the OSCAR number and should 19. correspond to the appropriate provider 20. type, as shown below (NOTE: SB = swing 21. bed): 22. Special Unit Prov. 23. Type 24. M - Psych unit in CAH 49 25. R - Rehab unit in CAH 50 26. S - Psych Unit 49 27. T - Rehab Unit 50 28. U - SB for short-term hosp. 51 29. W - SB for LTCH 52 30. Y - SB for Rehab 53 31. Z - SB for CAHs 54 effective_date: 1. Effective Date 2. Data File Format Title Description 3. Element Position 4. 3 17-24 9(8) Effective Date Must be numeric, CCYYMMDD. This is 5. the effective date of the provider's first PPS 6. period, or for subsequent PPS periods, the 7. effective date of a change to the PROV 8. file. If a termination date is present for this 9. record, the effective date must be equal to 10. or less than the termination date. 11. Year: Greater than 82, but not greater than 12. current year. 13. Month: 01-12 14. Day: 01-31 pps_waiver: 1. PPS Waiver Indicator (Y=Not Under PPS;N=Under PPS) 2. 7 49 X(1) Waiver Indicator Enter a “Y” or “N.” 3. Y = waived (Provider is not under PPS). 4. N = not waived (Provider is under PPS). provider_type: 1. Provider Type 2. 9 55-56 X(2) Provider Type This identifies providers that require 3. special handling. Enter one of the 4. following codes as appropriate. 5. 00 or blanks = Short Term Facility 6. 02 Long Term 7. 03 Psychiatric 8. 04 Rehabilitation Facility 9. 05 Pediatric 10. 06 Hospital Distinct Parts 11. (Provider type “06” is effective until July 1, 12. 2006. At that point, provider type “06” will 13. no longer be used. Instead, FIs will assign a 14. hospital distinct part as one of the following 15. provider types: 49, 50, 51, 52, 53, or 54) 16. 07 Rural Referral Center 17. 08 Indian Health Service 18. 13 Cancer Facility 19. 14 Medicare Dependent Hospital 20. (during cost reporting periods that 21. began on or after April 1, 1990). 22. 15 Medicare Dependent Hospital/Referral 23. Center 24. (during cost reporting periods that 25. began on or after April 1, 1990. Invalid 26. October 1, 1994 through September 30, 27. 1997). 28. 16 Re-based Sole Community Hospital 29. 17 Re-based Sole Community Hospital/ 30. Referral Center 31. 18 Medical Assistance Facility 32. 21 Essential Access Community Hospital 33. 22 Essential Access Community 34. Hospital/Referral Center 35. 23 Rural Primary Care Hospital 36. 32 Nursing Home Case Mix Quality Demo 37. Project – Phase II 38. 33 Nursing Home Case Mix Quality Demo 39. Project – Phase III – Step 1 40. 34 Reserved 41. 35 Hospice 42. 36 Home Health Agency 43. 37 Critical Access Hospital 44. 38 Skilled Nursing Facility (SNF) – For 45. Data File Format Title Description 46. Element Position 47. non-demo PPS SNFs – effective for 48. cost reporting periods beginning on or 49. after July 1, 1998 50. 40 Hospital Based ESRD Facility 51. 41 Independent ESRD Facility 52. 42 Federally Qualified Health Centers 53. 43 Religious Non-Medical Health Care 54. Institutions 55. 44 Rural Health Clinics-Free Standing 56. 45 Rural Health Clinics-Provider Based 57. 46 Comprehensive Outpatient Rehab 58. Facilities 59. 47 Community Mental Health Centers 60. 48 Outpatient Physical Therapy Services 61. 49 Psychiatric Distinct Part 62. 50 Rehabilitation Distinct Part 63. 51 Short-Term Hospital – Swing Bed 64. 52 Long-Term Care Hospital – Swing Bed 65. 53 Rehabilitation Facility – Swing Bed 66. 54 Critical Access Hospital – Swing Bed 67. NOTE: Provider Type values 49-54 refer 68. to special unit designations that are 69. assigned to the third position of the 70. OSCAR number (See field #2 for a special 71. unit-to-provider type cross-walk). division: 1. Census Division 2. 10 57 9(1) Current Census Must be numeric (1-9). Enter the Census 3. Division division to which the facility belongs for 4. payment purposes. When a facility is 5. reclassified for the standardized amount, 6. FIs must change the census division to 7. reflect the new standardized amount 8. location. Valid codes are: 9. 1 New England 10. 2 Middle Atlantic 11. 3 South Atlantic 12. 4 East North Central 13. 5 East South Central 14. 6 West North Central 15. 7 West South Central 16. Data File Format Title Description 17. Element Position 18. 8 Mountain 19. 9 Pacific 20. NOTE: When a facility is reclassified for 21. purposes of the standard amount, the FI 22. changes the census division to reflect the 23. new standardized amount location. pps_blend: 1. Federal PPS Blend Indicator 2. 18 75 X(1) Federal PPS HH PPS: Enter the code for the 3. Blend Indicator appropriate percentage payment to be made 4. on HH PPS RAPs. Must be present for all 5. HHA providers, effective on or after 6. 10/01/2000 7. Data File Format Title Description 8. Element Position 9. 0 = Pay standard percentages 10. 1 = Pay zero percent 11. IRF PPS: All IRFs are 100% Federal for 12. cost reporting periods beginning on or after 13. 10/01/2002. 14. LTCH PPS: Enter the appropriate code 15. for the blend ratio between federal and 16. facility rates. Effective for all LTCH 17. providers with cost reporting periods 18. beginning on or after 10/01/2002. 19. Federal % Facility% 20. 1 20 80 21. 2 40 60 22. 3 60 40 23. 4 80 20 24. 5 100 00 25. IPF PPS: Enter the appropriate code for 26. the blend ratio between federal and facility 27. rates. Effective for all IPF providers with 28. cost reporting periods beginning on or after 29. 1/1/2005. 30. Federal % Facility% 31. 1 25 75 32. 2 50 50 33. 3 75 25 34. 4 100 00 msa: 1. MSA - Actual Geographic Location 2. 12 59-62 X(4) Actual Enter the appropriate code for the MSA 3. Geographic 0040-9965, or the rural area, (blank) 4. Location - MSA (blank) 2 digit numeric State code such as 5. _ _36 for Ohio, where the facility is 6. physically located. fye: 1. Fiscal Year End Date - No Longer Used 2. 32 130-137 9(8) Fiscal Year End This field is no longer used. If present, 3. must be CCYYMMDD. casemixadj: 1. Case Mix Adjusted Cost Per Discharge/PPS Facility Specific Rate 2. 21 81-87 9(5)V9(2) Case Mix For PPS hospitals and waiver state non- 3. Adjusted Cost excluded hospitals, enter the base year cost 4. Per per discharge divided by the case mix 5. Discharge/PPS index. Enter zero for new providers. See 6. Facility Specific §20.1 for sole community and Medicare- 7. Rate dependent hospitals on or after 04/01/90. 8. For inpatient PPS hospitals, verify if figure 9. is greater than $10,000. For LTCH, verify 10. Data File Format Title Description 11. Element Position 12. if figure is greater than $35,000. cola: 1. Cost of Living Adjustment (COLA) 2. 22 88-91 9V9(3) Cost of Living Enter the COLA. All hospitals except 3. Adjustment Alaska and Hawaii use 1.000. 4. (COLA) resbed: 1. Intern/Resident to Bed Ratio 2. 23 92-96 9V9(4) Intern/Beds Enter the provider's intern/resident to bed 3. Ratio ratio. Calculate this by dividing the 4. provider's full time equivalent residents by 5. the number of available beds (as calculated 6. in positions 97-101). Do not include 7. residents in anesthesiology who are 8. employed to replace anesthetists or those 9. assigned to PPS excluded units. Base the 10. count upon the average number of full-time 11. equivalent residents assigned to the 12. hospital during the fiscal year. Correct 13. cases where there is reason to believe that 14. the count is substantially in error for a 15. particular facility. The FI is responsible 16. for reviewing hospital records and making 17. necessary changes in the count at the end 18. of the cost reporting period. 19. Enter zero for non-teaching hospitals. 20. IPF PPS: Enter the ratio of 21. residents/interns to the hospital’s average 22. daily census. spu_factor: 1. Special Provider Update Factor (Not Used as of 4/1/91) 2. 30 120-125 9V9(5) Special Provider Zero-fill for all hospitals after FY91. This 3. Update Factor Field is obsolete as of FY92. beds: 1. Bed Size 2. 24 97-101 9(5) Bed Size Enter the number of adult hospital beds and 3. pediatric beds available for lodging 4. inpatient. Must be greater than zero. (See 5. the Provider Reimbursement Manual, 6. §2405.3G.) dshop: 1. Operating Disproportionate Share Adjustment (DSH) Percentage (Not Used as of 10/1/91) 2. 31 126-129 V9(4) Operating DSH Disproportionate share adjustment 3. Percentage. Pricer calculates the Operating 4. DSH effective 10/1/91 and bypasses this 5. field. Zero-fill for all hospitals 10/1/91 and 6. later. opccr: 1. Operating Cost to Charge Ratio 2. Data File Format Title Description 3. Element Position 4. 25 102-105 9V9(3) Operating Cost Derived from the latest settled cost report 5. to Charge Ratio and corresponding charge data from the 6. billing file. Compute this amount by 7. dividing the Medicare operating costs by 8. Medicare covered charges. Obtain 9. Medicare operating costs from the 10. Medicare cost repot form CMS-2552-96, 11. Supplemental Worksheet D-1, Part II, Line 12. 53. Obtain Medicare covered charges from 13. the FI billing file, i.e., PS&R record. For 14. hospitals for which the FI is unable to 15. compute a reasonable cost-to-charge ratio, 16. they use the appropriate urban or rural 17. statewide average cost-to-charge ratio 18. calculated annually by CMS and published 19. in the "Federal Register." These average 20. ratios are used to calculate cost outlier 21. payments for those hospitals where you 22. compute cost-to-charge ratios that are not 23. within the limits published in the "Federal 24. Register." 25. For LTCH and IRF PPS, a combined 26. operating and capital cost-to-charge ratio is 27. entered here. 28. See below for a discussion of the use of 29. more recent data for determining CCRs. casemix: 1. Case Mix Index 2. 26 106-110 9V9(4) Case Mix Index The case mix index is used to compute 3. positions 81-87 (field 21). Zero-fill for all 4. others. In most cases, this is the case mix 5. index that has been calculated and 6. published by CMS for each hospital (based 7. on 1981 cost and billing data) reflecting the 8. relative cost of that hospital's mix of cases 9. compared to the national average mix. report_date: 1. Report Date 2. 5 33-40 9(8) Report Date Must be numeric, CCYYMMDD. 3. Date file created/run date of the PROV 4. report for submittal to CMS CO. intermediary: 1. Intermediary Number 2. Data File Format Title Description 3. Element Position 4. 8 50-54 9(5) Intermediary Assigned intermediary number. 5. Number fyb: 1. Fiscal Year Beginning Date 2. 4 25-32 9(8) Fiscal Year Must be numeric, CCYYMMDD. 3. Beginning Date Year: Greater than 81, but not greater than 4. current year. 5. Month: 01-12 6. Day: 01-31 7. Must be updated annually to show the 8. current year for providers receiving a 9. blended payment based on their FY begin 10. date. Must be equal to or less than the 11. effective date. passcap: 1. Pass Through Amount for Capital 2. 39 161-166 9(4)V9(2) Pass Through Per diem amount based on the interim 3. Amount for payments to the hospital. Must be zero if 4. Capital location 185 = A, B, or C (See the Provider 5. Reimbursement Manual, §2405.2). Used 6. for PPS hospitals prior to their cost 7. reporting period beginning in FY 92, new 8. hospitals during their first 2 years of 9. operation FY 92 or later, and non-PPS 10. hospitals or units. Zero-fill if this does not 11. apply. passdme: 1. Pass Through Amount for Durable Medical Equipment 2. 40 167-172 9(4)V9(2) Pass Through Per diem amount based on the interim 3. Amount for payments to the hospital (See the Provider, 4. Direct Medical Reimbursement Manual, §2405.2.). Zero- 5. Education fill if this does not apply. passorg: 1. Pass Through Amount for Organ Acquisition 2. 41 173-178 9(4)V9(2) Pass Through Per diem amount based on the interim 3. Amount for payments to the hospital. Include standard 4. Organ acquisition amounts for kidney, heart, lung, 5. Acquisition pancreas, intestine and liver transplants. 6. Do not include acquisition costs for bone 7. marrow transplants. (See the Provider 8. Reimbursement Manual, §2405.2.) Zero- 9. fill if this does not apply. passtot: 1. Pass Through Amount for Total Including Misc. 2. 42 179-184 9(4)V9(2) Total Pass Per diem amount based on the interim 3. Through payments to the hospital (See the Provider 4. Amount, Reimbursement Manual §2405.2.) Must be 5. Including at least equal to the three pass through 6. Miscellaneous amounts listed above. The following are 7. included in total pass through amount in 8. addition to the above pass through 9. amounts. Certified Registered Nurse 10. Anesthetists (CRNAs) are paid as part of 11. Miscellaneous Pass Through for rural 12. hospitals that perform fewer than 500 13. Data File Format Title Description 14. Element Position 15. surgeries per year, and Nursing and Allied 16. Health Professional Education when 17. conducted by a provider in an approved 18. program. Do not include amounts paid for 19. Indirect Medical Education, Hemophilia 20. Clotting Factors, or DSH adjustments. 21. Zero-fill if this does not apply. ssirat: 1. Supplemental Security Income (SSI) Ratio 2. 27 111-114 V9(4) Supplemental Enter the SSI ratio used to determine if the 3. Security Income hospital qualifies for a disproportionate 4. Ratio share adjustment and to determine the size 5. of the capital and operating DSH 6. adjustments. medicaidrat: 1. Medicaid Ratio 2. 28 115-118 V9(4) Medicaid Ratio Enter the Medicaid ratio used to determine 3. if the hospital qualifies for a 4. disproportionate share adjustment and to 5. determine the size of the capital and 6. operating DSH adjustments. termination_date: 1. Termination Date 2. 6 41-48 9(8) Termination Must be numeric, CCYYMMDD. 3. Date Termination Date in this context is the date 4. on which the reporting FI ceased servicing 5. the provider. Must be zeros or contain a 6. termination date. Must be equal to or 7. greater than the effective date. 8. If the provider is terminated or transferred 9. to another FI, a termination date is placed 10. in the file to reflect the last date the 11. provider was serviced by the outgoing FI. 12. Likewise, if the provider identification 13. number changes, the FI must place a 14. termination date in the PROV file 15. transmitted to CO for the old provider 16. identification number. msawi: 1. MSA - Wage Index Location 2. 13 63-66 X(4) Wage Index Enter the appropriate code for the MSA, 3. Location - MSA 0040-9965, or the rural area, (blank) 4. (blank) (2 digit numeric State code) such as 5. _ _ 3 6 for Ohio, to which a hospital has 6. been reclassified due to its prevailing wage 7. rates. Leave blank or enter the actual 8. location MSA (field 13), if not reclassified. 9. Pricer will automatically default to the 10. actual location MSA if this field is left 11. blank. lugar: 1. Change Code for Lugar Reclassification 2. 16 73 X(1) Change Code for Enter an "L" if the MSA has been 3. Lugar reclassified for wage index purposes under 4. reclassification §1886(d)(8)(B) of the Act. These are also 5. known as Lugar reclassifications, and 6. apply to ASC-approved services provided 7. on an outpatient basis when a hospital 8. qualifies for payment under an alternate 9. wage index MSA. 10. Leave blank for hospitals if there has not 11. been a Lugar reclassification. msastd: 1. MSA - Standardized Amount Location 2. 14 67-70 X(4) Standardized Enter the appropriate code for the MSA, 3. Amount MSA 0040-9965, or the rural area, (blank) 4. Location (blank) (2 digit numeric State code) such as 5. _ _ 3 6 for Ohio, to which a hospital has 6. been reclassified for standardized amount. 7. Leave blank or enter the actual location 8. MSA (field 13) if not reclassified. Pricer 9. will automatically default to the actual 10. location MSA if this field is left blank. sch_mdh: 1. Sole Community Hospital (SCH) Medical Dependent Hospital (MDH) Base Year 2. Data File Format Title Description 3. Element Position 4. 15 71-72 X(2) Sole Community Leave blank if not a sole community 5. or Medicare hospital (SCH) or a Medicare dependent 6. Dependent hospital (MDH) effective with cost 7. Hospital – Base reporting periods that begin on or after 8. Year April 1, 1990. If an SCH or an MDH, 9. show the base year for the operating 10. hospital specific rate, the higher of either 11. 82 or 87. See §20.6. Must be completed 12. for any SCH or MDH that operated in 82 13. or 87, even if the hospital will be paid at 14. the Federal rate. cap_pps: 1. Capital PPS Code 2. 43 185 X(1) Capital PPS Enter the code to indicate the type of 3. Payment Code capital payment methodology for hospitals: 4. A = Hold Harmless – cost payment for old 5. capital 6. B = Hold Harmless – 100% Federal rate 7. C = Fully prospective blended rate cap_rate: 1. Hospital Specfic Capital Rate 2. 44 186-191 9(4)V9(2) Hospital Specific Must be present unless: 3. Capital Rate • A "Y" is entered in the Capital 4. Indirect Medical Education Ratio 5. field; or 6. • A“08” is entered in the Provider 7. Type field; or 8. • A termination date is present in 9. Termination Date field. 10. Enter the hospital's allowable adjusted base 11. year inpatient capital costs per discharge. 12. This field is not used as of 10/1/02. cap_old: 1. Old Capital Hold Harmless Rate 2. 45 192-197 9(4)V9(2) Old Capital Hold Enter the hospital's allowable inpatient 3. Harmless Rate "old" capital costs per discharge incurred 4. for assets acquired before December 31, 5. 1990, for capital PPS. Update annually. cap_new: 1. New Capital Hold Harmless Ratio 2. 46 198-202 9V9(4) New Capital- Enter the ratio of the hospital's allowable 3. Hold Harmless inpatient costs for new capital to the 4. Ratio hospital's total allowable inpatient capital 5. costs. Update annually. capccr: 1. Capital Cost to Charge Ratio 2. 47 203-206 9V9(3) Capital Cost-to- Derived from the latest cost report and 3. Charge Ratio corresponding charge data from the billing 4. file. For hospitals for which the FI is 5. unable to compute a reasonable cost-to- 6. charge ratio, it uses the appropriate 7. statewide average cost-to-charge ratio 8. calculated annually by CMS and published 9. in the "Federal Register." A provider may 10. submit evidence to justify a capital cost-to- 11. charge ratio that lies outside a 3 standard 12. deviation band. The FI uses the hospital's 13. ratio rather than the statewide average if it 14. Data File Format Title Description 15. Element Position 16. agrees the hospital's rate is justified. 17. See below for a detailed description of the 18. methodology to be used to determine the 19. CCR for Acute Care Hospital Inpatient and 20. LTCH Prospective Payment Systems. new_hosp: 1. New Hospital 2. 48 207 X(1) New Hospital Enter "Y" for the first 2 years that a new 3. hospital is in operation. Leave blank if 4. hospital is not within first 2 years of 5. operation. capimerat: 1. Capital Indirect Medical Education Ratio 2. 49 208-212 9V9(4) Capital Indirect This is for IPPS hospitals and IRFs only. 3. Medical Enter the ratio of residents/interns to the 4. Education Ratio hospital's average daily census. Calculate 5. by dividing the hospital's full-time 6. equivalent total of residents during the 7. fiscal year by the hospital's total inpatient 8. days. (See §20.4.1 for inpatient acute 9. hospital and §§140.2.4.3 and 140.2.4.5.1 10. for IRFs.) Zero-fill for a non-teaching 11. hospital. capexprat: 1. Capital Exception Payment Ratio 2. 50 213-218 9(4)V9(2) Capital The per discharge exception payment to 3. Exception which a hospital is entitled. (See §20.4.7 4. Payment Rate above.) fyear: 1. October 1 is the beginning of the next fiscal year 2. For example, FY2000 begins 1999-10-01 and ends 2000-09-30 obs: 5,185 vars: 44 18 Feb 2018 08:09 size: 865,895 (_dta has notes) ------------------------------------------------------------------------------------------------- storage display value variable name type format label variable label ------------------------------------------------------------------------------------------------- provider str6 %9s * Provider Number effective_date int %td * Effective Date effective_datestr str6 %9s Effective Date pps_waiver str1 %9s * PPS Waiver Indicator (Y=Not Under PPS;N=Under PPS) provider_type byte %8.0g * Provider Type division str1 %9s * Census Division pps_blend str1 %9s * Federal PPS Blend Indicator msa str4 %9s * MSA - Actual Geographic Location fye int %td * Fiscal Year End Date - MMDDYY fyestr str6 %9s Fiscal Year End Date - MMDDYY casemixadj double %10.0g * Case Mix Adjusted Cost Per Discharge/PPS Facility Specific Rate cola double %10.0g * Cost of Living Adjustment (COLA) resbed double %10.0g * Intern/Resident to Bed Ratio spu_factor byte %10.0g * Special Provider Update Factor (Not Used as of 4/1/91) beds int %8.0g * Bed Size dshop int %10.0g * Operating Disproportionate Share Adjustment (DSH) Percentage (Not Used as of 10/ opccr double %10.0g * Operating Cost to Charge Ratio casemix double %10.0g * Case Mix Index report_date int %td * Report Date - MMDDYY report_datestr str6 %9s Report Date - MMDDYY intermediary long %10.0g * Intermediary Number fyb int %td * Fiscal Year Beginning Date - MMDDYY fybstr str6 %9s Fiscal Year Beginning Date - MMDDYY passcap long %10.0g * Pass Through Amount for Capital passdme long %10.0g * Pass Through Amount for Direct Medical Education passorg int %10.0g * Pass Through Amount for Organ Acquisition passtot long %10.0g * Pass Through Amount for Total Including Misc. ssirat int %10.0g * Supplemental Security Income (SSI) Ratio medicaidrat int %10.0g * Medicaid Ratio termination_date int %td * Termination Date - MMDDYY termination_datestr str6 %9s Termination Date - MMDDYY msawi str4 %9s * MSA - Wage Index Location lugar str1 %9s * Change Code for Lugar Reclassification msastd str4 %9s * MSA - Standardized Amount Location sch_mdh byte %8.0g * Sole Community Hospital (SCH) Medical Dependent Hospital (MDH) Base Year cap_pps str1 %9s * Capital PPS Code cap_rate long %10.0g * Hospital Specfic Capital Rate cap_old long %10.0g * Old Capital Hold Harmless Rate cap_new long %10.0g * New Capital Hold Harmless Ratio capccr double %10.0g * Capital Cost to Charge Ratio new_hosp str1 %9s * New Hospital capimerat long %10.0g * Capital Indirect Medical Education Ratio capexprat double %10.0g * Capital Exception Payment Ratio fyear int %9.0g * Fiscal Year (Based on Effective date) * indicated variables have notes ------------------------------------------------------------------------------------------------- Sorted by: provider effective_date