Physician Claims Information

Physician Claims data information is found on the Referral Source profile.

Physician Information


General physician information.

 Updated: Quarterly

 Current: Q1 2019

 Source: CMS Physician Compare, NPI Registry, Medicare Standard Analytic File (SAF), Proprietary Research

Column Description
Name The physicians name.
NPI The physician's National Provider Identifier (NPI).
Gender The physician's gender.
Credentials The physician's level of education and ability to provide care.
Graduation Year The physician's year of graduation.
Primary Affiliation The physician's primary company or hospital.
Primary Specialty The physicians primary medical specialty.
Medical School Where the physician attended and graduated medical school.
Accepts Medicare Whether or not the physician accepts Medicare.
Date Pulled The date Enquire received the data.
CBSA The Core Based Statistical Area (CBSA) code for the physician. CBSA's are geographic areas consisting of one more counties and at least 10,000 people.
Taxonomy Code The physician's Taxonomy Code. Taxonomy Codes categorize the type, classification, and/or specialization of a health care provider.
Medicare Payments The total amount paid by Medicare.
Medicare Charges The total amount charged to Medicare.
Medicare Claims The total number of claims submitted to Medicare
Medicare Allowed The maximum amount Medicare will pay for covered health care services.

Discharges


The companies or hospitals where the referring contact's patients are discharged.

 Updated: Annually in the fall

 Current: 1/1/2018-12/31/2018

 Source: Medicare Standard Analytics Files (SAF)

 Filters: Click the Summary, Hospital, HHA, SNF or Hospice buttons to update the discharge data for the selected Firm Type.

Column Description
Account The name of the company or hospital.
Network The company or hospital's network.
Firm Type The company or hospital's type.
City The city the company or hospital is located.
State The state the company or hospital is located.
In Network Whether or not the company or hospital is in the referring contact's network.
Number Claims The number of claims the referring contact has made to the company or hospital.
Discharges The number of discharges the referring contact has made to the company or hospital.
Medicare Charges The total amount of medicare charges from medicare claims.
Medicare Payments The total amount of medicare payments made for medicare claims.
Claim Type The claim type of the originating claim.

Firm Type Breakdown


Trended number of claims, unique patient, and same day referrals a physician is sending facilities.

 Updated: No Longer Updated by CMS

 Current: 2013-2015

 Source: Physician Referrals Database.

Column Description
   
   

Other IDs


The physicians additional Medicaid, Medicare, and other identifiers.

 Updated: Quarterly

 Current: Q4 2017

 Source: Physician compare, NPI Registry, Proprietary Research, DEA

Column Description
ID The identifier for the ID type.
ID Type The insurance id type.
Other Issue Ogranization/entity issuing the ID.
State The state the ID is valid.

Diagnosis Breakdown - ICD-10 Category


The top 10 ICD-10 Categories by the percentage of total claims.

 Updated: Annually in the fall

 Current: 2017

 Source: Medicare Standard Analytic File (SAF)

Top 10 DRG


The top 10 Diagnosis-related groups (DRG) based on the total number of claims.

 Updated: Annually in the fall

 Current: 2017

 Source: Medicare Standard Analytic File (SAF)

Column Description
DRG Description The description of the DRG.
DRG Code The code for the DRG.
Total Claims The total number of claims for the DRG.
Total Percentage The percent of total claims for the DRG.
Total Charges The estimated total charges for the DRG.
Total Payments The estimated total payments for the DRG.
Medicare Claims The number of Medicare claims for the DRG.
Medicare Charges The total of Medicare charges for the DRG.
Medicare Payments The total of Medicare payments for the DRG.
Was this article helpful?
0 out of 0 found this helpful