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Tip: Inpatient claims identification

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Number

0170

Submitting Entity (SE)

All

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Description

This tip provides data users with resources to identify/select inpatient claims in APCD data:

  1. Which variable(s) or combination of variables should we use to distinguish inpatient claims within this table?  The best way to identify an inpatient claim is to use Type of Bill (MC036).  https://achiapcd.atlassian.net/wiki/spaces/ADRS/pages/396099919/MC036.  Revenue Codes (MC054) can supplement this selection. https://achiapcd.atlassian.net/wiki/spaces/ADRS/pages/396165474/MC054

  2. How can the discharge date for an inpatient stay be determined?   If final discharge status (MC023) indicates the member has been discharged and the Discharge date (MC069) is not populated, use Service To date (MC060).

  3. What is the best approach to identify the discharge date for an inpatient stay in Medicare inpatient claims data (apcd_mcr_inp_clm)? Use NCH_BENE_DSCHRG_DT and reference this information:  https://resdac.org/cms-data/variables/nch-beneficiary-discharge-date

Active/Resolved

Active

Action / Resolution

Category 1

Inpatient claims

Category 2

Medicare

Tip / Issue

Tip

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