Ambulatory Surgery Center measures

Heart Attack Case

Number of cases with at least one secondary diagnosis for a heart attack

N/A

Yes

Yes

Heart Failure Case

Number of cases with at least one secondary diagnosis for heart failure

N/A

Yes

Yes

Pneumonia Case

Number of cases with at least one Secondary Diagnosis for pneumonia

N/A

Yes

Yes

Septicemia Case

Number of cases with at least one Secondary Diagnosis for septicemia

N/A

Yes

Yes

Stroke Case

Number of cases with at least one Secondary Diagnosis for a stroke

N/A

Yes

Yes

Usage - Blood Use

Percent of patients with Blood Use

Revenue codes: 0380-0387, 0389-0391, 0399

Low

No

Yes

Usage - CT Use

Percent of patients with CT Use

Revenue codes: 035X

Low

No

Yes

Usage - MRI Use

Percent of patients with MRI Use

Revenue codes: 0610-0612, 0614-0616, 0618, 0619

Low

No

Yes

Usage - Occupational Therapy Use

Percent of patients with Occupational Therapy charges

Revenue codes: 0430-0434, 0439

Usage - Physical Therapy Use

Percent of patients with Physical Therapy charges

Revenue codes: 0420-0424, 0429

Usage - Respiratory Therapy Use

Percent of patients with Respiratory Therapy charges

Revenue codes: 0410, 0412, 0413, 0419

Usage - Speech Therapy Use

Percent of patients with Speech Therapy charges

Revenue codes: 0440-0444, 0449, 0470-0472, 0479

Usage - PT, OT and Speech Therapy Use

Percent of patients with at least one revenue code for Physical Therapy, Occupational Therapy, or Speech Therapy

Revenue codes: 0420-0424, 0429-0434, 0439-0444, 0449

Low

No

Yes

OAS-CAHPS - Overall Rating (9 or 10)

Percent of patients who rated the facility a 9 or 10 (out of 10) for OAS-CAHPS question 23: Using any number from 0 to 10, where 0 is the worst facility possible and 10 is the best facility possible, what number would you use to rate this facility?

High

No

No

OAS-CAHPS - Recommendation (Definitely yes)

Percent of patients who indicated "definitely yes" for OAS-CAHPS survey question 24: Would you recommend this facility to your friends and family?

High

No

No

OAS-CAHPS - Doctor or staff provided information before procedure (Yes, definitely)

Percent of patients who indicated "yes, definitely" for OAS-CAHPS survey question 1: Before your procedure, did your doctor or anyone from the facility give you all the information you needed about your procedure?

High

No

No

OAS-CAHPS - Doctor or staff provided preparation instructions (Yes, definitely)

Percent of patients who indicated "yes, definitely" for OAS-CAHPS survey question 2: Before your procedure, did your doctor or anyone from the facility give you easy to understand instructions about getting ready for your procedure?

High

No

No

High

No

No

High

No

No

High

No

No

High

No

No

High

No

No

High

No

No

High

No

No

High

No

No

High

No

No

Mortality Rate

Number of deaths in-house divided by number of patients

Low

No

No

Mortality without Palliative Rate

Number of in-house deaths (excluding deaths of patients with palliative care) divided by number of patients

Low

No

No

Low

Yes

Yes

Number of in-house deaths (excluding deaths of patients with palliative care) divided by number of patients; numerator and denominator also exclude patients transferred in (4, A), transferred out (2, 5, 43, 82), or discharged Against Medical Advice (AMA: 7).

Low

Yes

Yes

ASC-1 Patient Burn

The number of discharges (patient encounters) who experience a burn prior to discharge from the ASC

See the QualityNet website for more information.

Low

No

No

ASC-2 Patient Fall

The number of discharges (patient encounters) who experience a fall within the ASC

See the QualityNet website for more information.

Low

No

No

ASC-3 Wrong Site, Wrong Side, Wrong Patient, Wrong Procedure, Wrong Implant

The number of discharges (patient encounters) who experience a wrong site, side, patient, procedure, or implant

See the QualityNet website for more information.

Low

No

No

ASC-4 Hospital Transfer/Admission

The percentage of ASC admissions (patients) who are transferred or admitted to a hospital upon discharge from the ASC

See the QualityNet website for more information.

Low

No

No

ASC-5 Prophylactic Intravenous (IV) Antibiotic Timing

Intravenous (IV) antibiotics given for prevention of surgical site infection were administered on time

NOTE: Measures ASC-5, -6, and -7 have been removed from the program beginning with January 1, 2017 encounters.

See the QualityNet website for more information.

Low

No

No

ASC-6 Safe Surgery Checklist Use

The use of a Safe Surgery Checklist for surgical procedures that includes safe surgery practices during each of the three critical perioperative periods: the period prior to the administration of anesthesia, the period prior to skin incision, and the period of closure of incision and prior to the patient leaving the operating room

NOTE: Measures ASC-5, -6, and -7 have been removed from the program beginning with January 1, 2017 encounters.

See the QualityNet website for more information.

Low

No

No

ASC-7 ASC Facility Volume Data on Selected ASC Surgical Procedures

The aggregate count of selected surgical procedures

NOTE: Measures ASC-5, -6, and -7 have been removed from the program beginning with January 1, 2017 encounters.

See the QualityNet website for more information.

Low

No

No

ASC-8 Influenza Vaccination Coverage among Healthcare Personnel

Percentage of Healthcare Personnel (HCP) who have received a flu vaccine.

See the QualityNet website for more information.

Facilities must report vaccination data for three categories of HCP: employees on payroll; licensed independent practitioners (who are physicians, advanced practice nurses, and physician assistants affiliated with the hospital but not on payroll); and students, trainees, and volunteers aged 18 or older. Show in Clinical Analytics only for personnel in the Physician Master File sent to Clinical Analytics.

Low

No

No

ASC-9 Endoscopy/Polyp Surveillance: Appropriate Follow-up Interval for Normal Colonoscopy in Average Risk Patients

Percentage of patients aged 50 to 75 years of age receiving a screening colonoscopy without biopsy or polypectomy who had a recommended follow-up interval of at least 10 years for repeat colonoscopy documented in their colonoscopy report

See the QualityNet website for more information.

Low

No

No

ASC-10 Endoscopy/Polyp Surveillance: Colonoscopy Interval for Patients with a History of Adenomatous Polyps - Avoidance of Inappropriate Use

Percentage of patients aged 18 years and older receiving a surveillance colonoscopy, with a history of a prior colonic polyp(s) in previous colonoscopy findings, who had a follow-up interval of 3 or more years since their last colonoscopy

See the QualityNet website for more information.

Low

No

No

ASC-11 Cataracts - Improvement in Patient's Visual Function within 90 days Following Cataract Surgery

Percentage of patients aged 18 years and older who had cataract surgery and had improvement in visual function achieved within 90 days following the cataract surgery, based on completing a pre-operative and post-operative visual function survey

See the QualityNet website for more information.

Low

No

No

ASC-12 Facility 7-Day Risk-Standardized Hospital Visit Rate after Outpatient Colonoscopy

The measure estimates a facility-level rate of risk-standardized, all-cause, unplanned hospital visits within 7 days of an outpatient colonoscopy among Medicare Fee-for-Service (FFS) patients aged 65 years and older.

See the QualityNet website for more information.

Low

No

No

% of surgical patients with order for 1st or 2nd gen. cephalosporin (NQF 0268, old PQRS 21)

Percentage of surgical patients aged 18 years and older undergoing procedures with the indications for a first OR second generation cephalosporin prophylactic antibiotic who had an order for a first OR second generation cephalosporin for antimicrobial prophylaxis

Low

No

No

Hours to Return (Any Patient Type)

Average number of hours from patient discharge date/time to subsequent admit date/time.

NOTE: The return encounter can be for any patient type.

High

No

No

Patient returns within 24 hours (Any Patient Type)

Percent of patients who were re-admitted as any patient type within 24 hours of discharge.

Low

No

No

Patient returns within 48 hours (Any Patient Type)

Percent of patients who were re-admitted as any patient type within 48 hours of discharge.

Low

No

No

Days to Return (Any Patient Type) - Decimal

Average number of days from patient discharge date/time to subsequent admit date/time.

NOTE: The return encounter can be for any patient type.

High

No

No

Patient returns within 7 days (Any Patient Type)

Percent of patients who were re-admitted as any patient type within 7 days of discharge.

Low

No

No

Patient returns within 14 days (Any Patient Type)

Percent of patients who were re-admitted as any patient type within 14 days of discharge.

Low

No

No

Patient returns within 30 days (Any Patient Type)

Percent of patients who were re-admitted as any patient type within 30 days of discharge.

Low

No

No

Hours to Return to ED

Average number of hours from patient discharge date/time to subsequent Emergency Department admit date/time.

High

No

No

Patient returns to ED within 24 hours

Percent of patients who were re-admitted to the Emergency Department within 24 hours of discharge.

Low

No

No

Patient returns to ED within 48 hours

Percent of patients who were re-admitted to the Emergency Department within 48 hours of discharge.

Low

No

No

Days to Return to ED - Decimal

Average number of days from patient discharge date/time to subsequent Emergency Department admit date/time.

High

No

No

Patient returns to ED within 7 days

Percent of patients who were re-admitted to the Emergency Department within 7 days of discharge.

Low

No

No

Patient returns to ED within 14 days

Percent of patients who were re-admitted to the Emergency Department within 14 days of discharge.

Low

No

No

Patient returns to ED within 30 days

Percent of patients who were re-admitted to the Emergency Department within 30 days of discharge.

Low

No

No

Hours to Return to Surgery

Average number of hours from patient discharge date/time to subsequent surgery encounter admit date/time.

NOTE: The returns include inpatient encounters with a surgical MS-DRG and ASC (outpatient ambulatory surgery) encounters.

High

No

No

Patient returns to Surgery within 24 hours

Percent of patients who were re-admitted as a surgical patient within 24 hours of discharge.

NOTE: The returns include inpatient encounters with a surgical MS-DRG and ASC (outpatient ambulatory surgery) encounters.

Low

No

No

Patient returns to Surgery within 48 hours

Percent of patients who were re-admitted as a surgical patient within 48 hours of discharge.

NOTE: The returns include inpatient encounters with a surgical MS-DRG and ASC (outpatient ambulatory surgery) encounters.

Low

No

No

Days to Return to Surgery - Decimal

Average number of days from patient discharge date/time to subsequent surgery encounter admit date/time.

NOTE: The returns include inpatient encounters with a surgical MS-DRG and ASC (outpatient ambulatory surgery) encounters.

High

No

No

Patient returns to Surgery within 7 days

Percent of patients who were re-admitted as a surgical patient within 7 days of discharge.

NOTE: The returns include inpatient encounters with a surgical MS-DRG and ASC (outpatient ambulatory surgery) encounters.

Low

No

No

Patient returns to Surgery within 14 days

Percent of patients who were re-admitted as a surgical patient within 14 days of discharge.

NOTE: The returns include inpatient encounters with a surgical MS-DRG and ASC (outpatient ambulatory surgery) encounters.

Low

No

No

Volume

Count of inpatient discharges

High

No

No

Gender - Female

Number of female patients divided by the total number of discharges

N/A

No

No

Gender - Male

Number of male patients divided by the total number of discharges

N/A

No

No

% Admitted As an Inpatient to This Hospital

Percent of outpatient encounters admitted as an inpatient to this hospital:

Number of encounters with Discharge Disposition=9 divided by the total number of discharges

N/A

Yes

Yes

% Discharged To Home / Self Care (Routine Discharge)

Percent of patients discharged to home or self-care (routine discharge):

Number of encounters with Discharge Disposition=1 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred / Referred To another Institution for Outpatient Services

Percent of patients discharged, transferred, or referred to another institution for outpatient services:

Number of encounters with Discharge Disposition=71 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred / Referred To This Institution for Outpatient Services

Percent of patients discharged, transferred, or referred to this institution for outpatient services:

Number of encounters with Discharge Disposition=72 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To Home Care

Percent of patients discharged or transferred to Home Care:

Number of encounters with Discharge Disposition=6 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To a Long Term Care

Percent of patients discharged or transferred to a long-term care facility:

Number of encounters with Discharge Disposition=63 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To a Nursing Facility

Percent of patients discharged or transferred to a nursing facility:

Number of encounters with Discharge Disposition=64 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To an Inpatient Rehabilitation Facility

Percent of patients discharged or transferred to an inpatient rehabilitation facility:

Number of encounters with Discharge Disposition=62 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To another Type of Institution for Inpatient Care

Percent of patients discharged or transferred to another type of institution for inpatient care:

Number of encounters with Discharge Disposition=5 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To Home under Care of a Home IV Drug Therapy Provider

Percent of patients discharged or transferred to home under care of a home iv drug therapy provider:

Number of encounters with Discharge Disposition=8 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To Intermediate Care Facility

Percent of patients discharged or transferred to intermediate care facility:

Number of encounters with Discharge Disposition=4 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To Other Short Term General Hospital for Inpatient Care

Percent of patients discharged or transferred to other short-term general hospital for inpatient care:

Number of encounters with Discharge Disposition=2 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred To Skilled Nursing Facility (SNF)

Percent of patients discharged or transferred to skilled nursing facility (SNF):

Number of encounters with Discharge Disposition=3 divided by the total number of discharges

N/A

Yes

Yes

% Discharged / Transferred Within This Institution to a Hospital-Based Medicare Approved Swing Bed

Percent of patients discharged or transferred within this institution to a hospital-based Medicare-approved swing bed:

Number of encounters with Discharge Disposition=61 divided by the total number of discharges

N/A

Yes

Yes

% Discharged/transferred to a Critical Access Hospital (CAH)

Percent of patients discharged or transferred to a critical access hospital (CAH):

Number of encounters with Discharge Disposition=66 divided by the total number of discharges

N/A

Yes

Yes

% Discharged/transferred to a federal hospital

Percent of patients discharged or transferred to a federal hospital:

Number of encounters with Discharge Disposition=43 divided by the total number of discharges

N/A

Yes

Yes

% Discharged/Transferred to a psychiatric hospital or psychiatric distinct unit of a hospital

Percent of patients discharged or transferred to a psychiatric hospital or psychiatric distinct unit of a hospital:

Number of encounters with Discharge Disposition=65 divided by the total number of discharges

N/A

Yes

Yes

% Expired - At Home (Hospice Claims Only)

Percent of patients discharged expired - at home (hospice claims only):

Number of encounters with Discharge Disposition=40 divided by the total number of discharges

N/A

Yes

Yes

% Expired - Did Not Recover (Christian Science Patient)

Percent of patients discharged expired (or "did not recover" for Christian Science patients):

Number of encounters with Discharge Disposition=20 divided by the total number of discharges

N/A

Yes

Yes

% Expired - In a Medical Facility Such as Hospital, SNF, ICF, or Freestanding Hospice

Percent of patients discharged expired from a medical facility such as hospital, SNF, ICF, or freestanding hospice:

Number of encounters with Discharge Disposition=41 divided by the total number of discharges

N/A

Yes

Yes

% Expired - Place Unknown (Hospice Claims Only)

Percent of patients discharged expired - place unknown (hospice claims only):

Number of encounters with Discharge Disposition=42 divided by the total number of discharges

N/A

Yes

Yes

% Hospice - Home

Percent of patients discharged to hospice - home:

Number of encounters with Discharge Disposition=50 divided by the total number of discharges

N/A

Yes

Yes

% Hospice - Medical Facility

Percent of patients discharged to hospice - medical facility:

Number of encounters with Discharge Disposition=51 divided by the total number of discharges

N/A

Yes

Yes

% Left Against Medical Advice or Discontinued Care

Percent of patients who left against medical advice (AMA) or discontinued care:

Number of encounters with Discharge Disposition=7 divided by the total number of discharges

N/A

Yes

Yes

Observation Hours

Average number of observation days per patient

Revenue Codes: 0762, 0760

Low

No

No

Patient Stayed Two Midnights

Flag of 0 or 1, where 1 indicates that a given encounter was discharged at least two midnights after admission

Low

No

Yes

Charges - Total

Sum of all charges divided by volume of cases

Low

No

Yes

Charges - Ambulance

Sum of ambulance charges divided by volume of cases

Revenue codes: 0540-0549

Low

No

Yes

Charges - Anesthesiology

Sum of anesthesiology charges divided by volume of cases

Revenue codes: 0370-0372, 0374, 0379

Low

No

Yes

Charges - Blood Administration

Sum of blood administration charges divided by volume of cases

Revenue codes: 0390, 0391, 0399

Low

No

Yes

Charges - Blood Use

Sum of blood use charges divided by volume of cases

Revenue codes: 0380-0387, 0389

Low

No

Yes

Charges - Cardiology

Sum of cardiology charges divided by volume of cases

Revenue codes: 0480-0483, 0489, 0730-0732, 0739

Low

No

Yes

Charges - Clinic Visit

Sum of clinic visit charges divided by volume of cases

Revenue codes: 0510-0517, 0519

Low

No

Yes

Charges - Durable Medical Equipment

Sum of durable medical equipment charges divided by volume of cases

Revenue codes: 0290-0292, 0294, 0299

Low

No

Yes

Charges - Emergency Department

Sum of emergency room department charges divided by volume of cases

Revenue codes: 0450-0452, 0456, 0459

Low

No

Yes

Charges - ESRD Revenue Setting

Sum of ESRD revenue-setting charges divided by volume of cases

Revenue codes: 0800-0804, 0809, 0820-0825, 0829-0835, 0839-0845, 0849-0855, 0859-0882, 0889

Low

No

Yes

Charges - Labor and Delivery

Sum of labor and delivery charges divided by volume of cases

Revenue codes: 0720-0724, 0729

Low

No

Yes

Charges - Laboratory and Pathology

Sum of laboratory& pathology charges divided by volume of cases

Revenue codes: 0300-0307, 0309-0312, 0314, 0319, 0740, 0749, 0750, 0759

Low

No

Yes

Charges - Lithotripsy

Sum of lithotripsy charges divided by volume of cases

Revenue codes: 0790, 0799

Low

No

Yes

Charges - Medical/Surgical Supplies

Sum of medical/surgical supply charges divided by volume of cases

Revenue codes: 0270-0279, 0620-0624

Low

No

Yes

Charges - MRI

Sum of MRI charges divided by volume of cases

Revenue codes: 0610-0612, 0614-0616, 0618, 0619

Low

No

Yes

Charges - Nuclear Medicine

Sum of nuclear medicine charges divided by volume of cases

Revenue codes: 340-342, 349

Low

No

Yes

Charges - Nursery and NICU

Sum of nursery and NICU Charges divided by volume of cases

Revenue codes: 0230-0232, 0234, 0235, 0239, 0240, 0249

Low

No

Yes

Charges - Occupation Therapy

Sum of occupational therapy charges divided by volume of cases

Revenue codes: 0430-0434, 0439

Low

No

Yes

Charges - Oncology

Sum of oncology charges divided by volume of cases

Revenue codes: 0280, 0289, 0331-0333, 0335

Low

No

Yes

Charges - Operating Room and Labor & Delivery

Sum of operating room labor and delivery charges divided by volume of cases

Revenue codes: 0360-0362, 0367, 0369, 0710, 0719, 0720-0724, 0729

Low

No

Yes

Charges - Organ Acquisition

Sum of organ acquisition charges divided by volume of cases

Revenue codes: 0810-0814, 0819, 0890-0893, 0899

Low

No

Yes

Charges - Other

Sum of other charges divided by volume of cases

Revenue codes: 0220-0224, 0229-0235, 0239, 0240, 0249, 0520-0523, 0526, 0529, 0530, 0531, 0539, 0550-0553, 0559-0562, 0569-0572, 0579-0583, 0589, 0590, 0599-0604, 0640-0652, 0655-0663, 0669-0672, 0679, 0681-0684, 0689, 0700, 0709, 0760-0762, 0769-0771, 0779, 0780, 0900, 0901-0907, 0909-0925, 0929, 0931, 0932, 0940-0947, 0949-0952, 0990-0999

Low

No

Yes

Charges - Other Not Including Nursery and NICU and Psych

Sum of other charges (without NICU or psych) divided by volume of cases

Revenue codes: 0220-0224, 0229, 0520-0523, 0526, 0529-0531, 0539, 0550-0553, 0559-0562, 0569-0572, 0579-0583, 0589, 0590, 0599-0604, 0640-0652, 0655-0663, 0669-0672, 0679, 0681-0684, 0689, 0700, 0709, 0760-0762, 0769-0771, 0779, 0780, 0920-0925, 0929, 0931, 0932, 0940-0947, 0949-0952, 0990-0999

Low

No

Yes

Charges - Outpatient Services

Sum of outpatient services charges divided by volume of cases

Revenue codes: 0490, 0499, 0500, 0509

Low

No

Yes

Charges - Pathology

Sum of pathology charges divided by volume of cases

Revenue codes: 0310-0312, 0314, 0319

Low

No

Yes

Charges - Pharmacy

Sum of pharmacy charges divided by volume of cases

Revenue codes: 0250-0263, 0264, 0269, 0630-0637

Low

No

Yes

Charges - Physical Therapy

Sum of physical therapy charges divided by volume of cases

Revenue codes: 0420-0424, 0429

Low

No

Yes

Charges - Professional Fee

Sum of professional fees charges

Revenue codes: 0960-0964, 0969, 0971-0979, 0981-0989

Low

No

Yes

Charges - Psych Services

Sum of psych charges divided by volume of cases

Revenue codes: 0900-0907, 0909-0919

Low

No

Yes

Charges - Radiology and CT Scan

Sum of radiology and CT scan charges divided by volume of cases

Revenue codes: 0320-0324, 0329, 0350-0352, 0359, 0400-0404, 0409

Low

No

Yes

Charges - Radiology, CT, Oncology & Nuclear Med.

Sum of radiology charges divided by volume of cases

Revenue codes: 0280, 0289, 0320-0324, 0329-0333, 0335, 0339-0342, 0349-0352, 0359, 0400-0404, 0409

Low

No

Yes

Charges - Respiratory Services

Sum of respiratory services charges divided by volume of cases

Revenue codes: 0410, 0412, 0413, 0419

Low

No

Yes

Charges - Respiratory Therapy

Sum of inhalation therapy charges divided by volume of cases

Revenue codes: 0410, 0412, 0413, 0419

Low

No

Yes

Charges - Speech Pathology

Sum of speech pathology charges divided by volume of cases

Revenue codes: 0440-0444, 0449, 0470-0472, 0479

Low

No

Yes

Charges - Therapy: Physical, Occupational, Speech

Sum of physical, occupational and speech therapy divided by volume of cases

-Physical therapy revenue codes: 0420-0424, 0429

-Occupational therapy revenue codes: 0430-0434, 0439

-Speech pathology revenue codes: 0440-0444, 0449, 0470-0472, 0479

Low

No

Yes

Charges - Used Durable Medical Equipment

Sum of used durable medical equipment charges divided by volume of cases

Revenue code: 0293

Low

No

Yes

Cost - Total

Sum of all costs divided by volume of cases

Low

No

Yes

Cost - Ambulance

Sum of ambulance costs divided by volume of cases

Revenue codes: 0540-0549

Low

No

Yes

Cost - Anesthesiology

Sum of anesthesiology costs divided by volume of cases

Revenue codes: 0370-0372, 0374, 0379

Low

No

Yes

Cost - Blood Administration

Sum of blood administration costs divided by volume of cases

Revenue codes: 0390, 0391, 0399

Low

No

Yes

Cost - Blood Use

Sum of blood use costs divided by volume of cases

Revenue codes: 0380-0387, 0389

Low

No

Yes

Cost - Cardiology

Sum of cardiology costs divided by volume of cases

Revenue codes: 0480-0483, 0489, 0730-0732, 0739

Low

No

Yes

Cost - Clinic Visit

Sum of clinic visit costs divided by volume of cases

Revenue codes: 0510-0517, 0519

Low

No

Yes

Cost - Durable Medical Equipment

Sum of durable medical equipment costs divided by volume of cases

Revenue codes: 0290-0292, 0294, 0299

Low

No

Yes

Cost - Emergency Department

Sum of emergency room department costs divided by volume of cases

Revenue codes: 0450-0452, 0456, 0459

Low

No

Yes

Cost - ESRD Revenue Setting

Sum of ESRD revenue-setting costs divided by volume of cases

Revenue codes: 0800-0804, 0809, 0820-0825, 0829-0835, 0839-0845, 0849-0855, 0859-0882, 0889

Low

No

Yes

Cost - Intermediate ICU/CCU

Sum of intermediate ICU/ CCU costs (Revenue codes 206 and 214) divided by volume of cases

Revenue codes: 206, 214

Low

No

Yes

Cost - Labor and Delivery

Sum of labor and delivery costs divided by volume of cases

Revenue codes: 0720-0724, 0729

Low

No

Yes

Cost - Laboratory and Pathology

Sum of laboratory& pathology costs divided by volume of cases

Revenue codes: 0300-0307, 0309-0312, 0314, 0319, 0740, 0749, 0750, 0759

Low

No

Yes

Cost - Lithotripsy

Sum of lithotripsy costs divided by volume of cases

Revenue codes: 0790, 0799

Low

No

Yes

Cost - Medical/Surgical Supplies

Sum of medical/surgical supplies divided by volume of cases

Revenue codes: 0270-0279, 0620-0624

Low

No

Yes

Cost - MRI

Sum of MRI costs divided by volume of cases

Revenue codes: 0610-0612, 0614-0616, 0618, 0619

Low

No

Yes

Cost - Nuclear Medicine

Sum of nuclear medicine costs divided by volume of cases

Revenue codes: 340-342, and 349

Low

No

Yes

Cost - Nursery and NICU

Sum of nursery and NICU costs divided by volume of cases

Revenue codes: 0230-0232, 0234, 0235, 0239, 0240, 0249

Low

No

Yes

Cost - Occupation Therapy

Sum of occupational therapy costs divided by volume of cases

Revenue codes: 0430-0434, 0439

Low

No

Yes

Cost - Oncology

Sum of oncology costs divided by volume of cases

Revenue codes: 0280, 0289, 0331-0333, 0335

Low

No

Yes

Cost - Operating Room and Labor & Delivery

Sum of operating room labor and delivery costs divided by volume of cases

Revenue codes: 0360- 0362, 0367, 0369, 0710, 0719, 0720-0724, 0729

Low

No

Yes

Cost - Organ Acquisition

Sum of organ acquisition costs divided by volume of cases

Revenue codes: 0810-0814, 0819, 0890-0893, 0899

Low

No

Yes

Cost - Other

Sum of other costs divided by volume of cases

Revenue codes: 0220-0224, 0229-0235, 0239, 0240, 0249, 0520-0523, 0526, 0529-0531, 0539, 0550-0553, 0559-0562, 0569-0572, 0579-0583, 0589, 0590, 0599-0604, 0640-0652, 0655-0663, 0669-0672, 0679, 0681-0684, 0689, 0700, 0709, 0760-0762, 0769-0771, 0779, 0780, 0900-0907, 0909, 0910-0925, 0929, 0931, 0932, 0940-0947, 0949-0952, 0990-0999

Low

No

Yes

Cost - Other Not Including Nursery and NICU and Psych

Sum of other costs (without NICU or psych) divided by volume of cases

Revenue codes: 0220-0224, 0229, 0520-0523, 0526, 0529-0531, 0539, 0550-0553, 0559-0562, 0569-0572, 0579-0583, 0589, 0590, 0599-0604, 0640-0652, 0655-0663, 0669-0672, 0679, 0681-0684, 0689, 0700, 0709, 0760-0762, 0769-0771, 0779, 0780, 0920-0925, 0929, 0931, 0932, 0940-0947, 0949-0952, 0990-0999

Low

No

Yes

Cost - Outpatient Services

Sum of outpatient services costs divided by volume of cases

Revenue codes: 0490, 0499, 0500, 0509.

Low

No

Yes

Cost - Pathology

Sum of pathology costs divided by volume of cases

Revenue codes: 0310-0312, 0314, 0319.

Low

No

Yes

Cost - Pharmacy

Sum of pharmacy costs divided by volume of cases

Revenue codes: 0250-0264, 0269, 0630-0637.

Low

No

Yes

Cost - Physical Therapy

Sum of physical therapy costs divided by volume of cases

Revenue codes: 0420-0424, 0429.

Low

No

Yes

Cost - Professional Fee

Sum of professional fees costs

Revenue codes: 0960-0964, 0969, 0971-0979, 0981-0989

Low

No

Yes

Cost - Psych Services

Sum of psych costs divided by volume of cases

Revenue codes: 0900-0907, 0909-0919

Low

No

Yes

Cost - Radiology and CT Scan

Sum of radiology and CT scan costs divided by volume of cases

Revenue codes: 0320-0324, 0329, 0350-0352, 0359, 0400-0404, 0409

Low

No

Yes

Cost - Radiology, CT, Oncology & Nuclear Med.

Sum of radiology costs divided by volume of cases

Revenue codes: 0280, 0289, 0320-0324, 0329-0333, 0335, 0339-0342, 0349-0352, 0359, 0400-0404, 0409

Low

No

Yes

Cost - Respiratory Services

Sum of respiratory services costs divided by volume of cases

Revenue codes: 0410, 0412, 0413, 0419

Low

No

Yes

Cost - Respiratory Therapy

Sum of inhalation therapy costs divided by volume of cases

Revenue codes: 0410, 0412, 0413, 0419

Low

No

Yes

Cost - Speech Pathology

Sum of speech pathology costs divided by volume of cases

Revenue codes: 0440-0444, 0449, 0470-0472, 0479

Low

No

Yes

Cost - Therapy: Physical, Occupational, Speech

Sum of physical, occupational, and speech therapy divided by volume of cases

-Physical therapy revenue codes: 0420-0424, 0429

-Occupational therapy revenue codes: 0430-0434, 0439

-Speech pathology revenue codes: 0440-0444, 0449, 0470-0472, 0479

Low

No

Yes

Cost - Used Durable Medical Equipment

Sum of used durable medical equipment costs divided by volume of cases

Revenue code: 0293

Low

No

Yes

Total Indirect Costs

Total indirect costs as defined in client’s cost accounting system.

Low

No

Yes

Total Direct Costs

Total direct costs as defined in client’s cost accounting system.

Low

No

Yes

Total Variable Costs

Total variable costs as defined in client’s cost accounting system.

Low

No

No

Total Fixed Costs

Total fixed costs as defined in client’s cost accounting system.

Low

No

No

Contractual Allowance and Adjustments

Contractual allowance and adjustments equals charges minus total actual payment

Low

No

No

LOS (hours)

Average length of stay, in hours, for all patients

Low

No

Yes

Number of Consultants

Number of consultant physicians utilized for this encounter

Low

No

Yes

Expected Payment

Total expected payment as defined in client’s cost accounting system.

Low

No

No

Total Actual Payment

Total actual payment as defined in client’s cost accounting system.

Low

No

No

Expected Net Income

Expected total actual payment minus total costs

High

No

No

Net Income

Net Income equals total actual payment minus total costs

High

No

No

Expected Contribution Margin

Expected Total Actual Payment minus Total Variable Costs

High

No

No

Contribution Margin

Total Actual Payment minus Total Variable Costs

High

No

No

Medicare Contribution Margin

Total Actual Medicare Payment minus Total Variable Costs

High

No

No

Medicare Net Income

Total actual Medicare payment minus total costs

High

No

No

Final Billed

A flag indicating if the account has been Final Billed

High

No

No

Patient Payment at POS

Amount of patient payment made on the date(s) of service

High

No

No

Patient Pay Write-Off

Sum of all charge amounts written off by the provider because the patient did not pay them

Low

No

No

Charity Care

Sum of all charges discounted by the facility as free or reduced-cost care for patient in financial hardship

Low

No

No

Other Adjustments

Sum of all other adjustments made to the Open Balance

Low

No

No

Payments - Patient

Sum of all payments made to an account by the patient (classified "Self")

Low

No

No

Payments - Insurance

Sum of all payments made to an account by an insurance provider; this includes Blue Cross/Blue Shield, Champus/Tricare/VA, CHP, Medicaid, Medicare, Other Govt, Private Ins, Workers Compensation and possibly others.

Low

No

No

Payments - Total

Sum of all Patient and Insurance payments made to an account

Low

No

No

Contractual Allowance

Sum of all Contractual Allowance adjustments made to an account; contractual allowance refers to the amount an insurance company does not pay to an account because of previous agreements with the facility as to the charges for a service.

Low

No

No

Denials

Sum of all charge amounts denied by insurance

Low

No

No

Payments - Other

Sum of all payments made to a patient account not classified as "Insurance" or "Patient Pay"; this can include Charity, Other, Unknown, and missing values.

Low

No

No

Employee Discount

Sum of all Employee Discount adjustments made to an account

Low

No

No

Self-Pay Discount

Sum of all Self-Pay Discount adjustments made to an account

Low

No

No

Aging Category (366+)

Account was paid in full (Open Balance = $0) over 365 days of the patient discharge date

N/A

No

No

Aging Category (181-365)

Account was paid in full (Open Balance = $0) within 181-365 days of the patient discharge date

N/A

No

No

Aging Category (151-180)

Account was paid in full (Open Balance = $0) within 151-180 days of the patient discharge date

N/A

No

No

Aging Category (121-150)

Account was paid in full (Open Balance = $0) within 121-150 days of the patient discharge date

N/A

No

No

Aging Category (91-120)

Account was paid in full (Open Balance = $0) within 91-120 days of the patient discharge date

N/A

No

No

Aging Category (61-90)

Account was paid in full (Open Balance = $0) within 61-90 days of the patient discharge date

N/A

No

No

Aging Category (31-60)

Account was paid in full (Open Balance = $0) within 31-60 days of the patient discharge date

N/A

No

No

Aging Category (0-30)

Account was paid in full (Open Balance = $0) within 30 days of the patient discharge date

N/A

No

No

Aging Category - Closed to Zero Balance

A letter designating the aging category of the account based on the Zero Balance Age. Category assignments are as follows:

A represents 0-30 days; B represents 31-60 days; C represents 61-90 days; D represents 91-120 days; E represents 121-150 days; F represents 151-180 days; G represents 181-365 days; and H represents 366+ days

N/A

No

No

Zero Balance Age (in Days)

Number of days from the patient discharge date to the date when Open Balance is equal to $0

Low

No

No

Open Balance

Total open balance on the account

Low

No

No