[DM/URSA-CORE] Data Mart for SNF Encounters

Object Description

One record per Skilled Nursing Facility encounter, including, if they occur prior to inpatient admission, ED visits and/or observation stays.

Metadata

• Table Name: ursa.dm_ursa_core_007
• Layer: DATA_MART
• Object Type: Single Stack
• Temporal Class: Event
• Case ID: Encounter ID
• Event Date: Encounter Start Date
• Primary Key: Encounter ID

Published Fields

• Data Model Keys

  • Encounter ID -- The internal database identifier (used, e.g., for joins and primary keys) for the encounter. (See also [URSA-CORE] Encounter)
  • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
  • Encounter Primary Payor ID -- Data model key for the primary payor documented in the billing for an encounter.
  • Encounter Primary Plan ID -- Data model key for the primary plan documented in the billing for an encounter.
  • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
  • Attending Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the attending provider. (See also [URSA-CORE] Attending Provider)

• Date Fields

  • Encounter Start Date
  • Encounter End Date

• Encounter Fields

  • Encounter LOS in Elapsed Midnights
  • Encounter LOS in Distinct Calendar Days
  • Encounter Calendar Days LOS Category Tier 1
  • Is LOS in Days > 100
  • Is Discharge Status Home or Home with Home Health
  • Is Routine Discharge Home
  • Is Discharged Home with Home Health

• Diagnosis Fields

  • Principal Discharge Diagnosis ICD-10-CM Code
  • Principal Discharge Diagnosis ICD-10-CM Description
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
  • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description

• Clinical Services Fields

  • MS-DRG Code -- The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.
  • MS-DRG Description -- The natural language description of a standard 3-digit Medicare Severity Diagnosis Related Group code.
  • MS-DRG MDC Code
  • MS-DRG MDC Description
  • Is CMS DRG Medical-Surgical Type Medical
  • Is CMS DRG Medical-Surgical Type Surgical
  • CMS DRG Weight
  • CMS DRG Arithmetic Mean LOS -- The arithmetic mean length of stay (ALOS) is the average length of stay experienced by a patient within a chosen DRG. (See also [URSA-CORE] CMS DRG Geometric Mean LOS)
  • CMS DRG Geometric Mean LOS -- The geometric mean length of stay or (GMLOS) is the national mean length of stay for each diagnostic related grouper (DRG) as determined and published by CMS. The geometric mean reduces the effect of very high or low values, which might bias the mean if a straight average (arithmetic mean) is used. (See also [URSA-CORE] CMS DRG Arithmetic Mean LOS)

• Provider Fields

  • Facility Provider Description
  • Facility Provider Primary NUCC Provider Taxonomy Code
  • Facility Provider Primary NUCC Provider Taxonomy Description
  • Attending Provider Description
  • Attending Provider Primary NUCC Provider Taxonomy Code
  • Attending Provider Primary NUCC Provider Taxonomy Description

• Location Fields

  • Facility Provider Practice Address ZIP Code 5-Digit
  • Facility Provider Practice Address State Abbreviation
  • Facility Provider Dartmouth Atlas HRR ID
  • Facility Provider Dartmouth Atlas HRR Description

• Insurance Fields

  • Encounter Primary Payor Description
  • Encounter Primary Plan Description
  • Encounter Primary Plan Financial Class Description
  • Is Encounter Primary Plan Financial Class Commercial
  • Is Encounter Primary Plan Financial Class Medicare FFS
  • Is Encounter Primary Plan Financial Class Medicare Advantage
  • Is Encounter Primary Plan Financial Class Medicaid

• Billing and Claims Fields

  • CMS Admit Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.
  • CMS Admit Source Description
  • CMS Admit Type Code -- The standard single-digit CMS inpatient admission type code found on Inpatient and Skilled Nursing Facility claims; ; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available.
  • CMS Admission Type Description
  • CMS Place of Service Code -- The standard CMS 2-digit Place of Service code; e.g., 01 = Pharmacy, 02 = Telehealth, etc.
  • CMS Place of Service Description
  • CMS Patient Discharge Status Code -- The standard 2-digit CMS Patient Discharge Status code; 01 = Discharged to Home or Self Care, etc. Patient Discharge Status codes should include leading zeros.
  • CMS Patient Discharge Status Description

• Financial Fields

  • Total Plan Paid Amount from All Plans
  • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
  • Primary Plan Allowed Amount -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
  • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.
  • Encounter Total Plan Paid Amount Category
  • Is Encounter with Zero Dollar Plan Paid Amount
  • Average Calendar Day Plan Paid Amount
  • Average Calendar Day Patient Paid Amount

Foreign Keys

• pat_id → ursa.no_ursa_core_pat_001.pat_id
• enc_primary_payor_id → ursa.no_ursa_core_struct_004.payor_id
• enc_primary_plan_id → ursa.no_ursa_core_struct_005.plan_id
• facility_prov_id → ursa.no_ursa_core_prov_001.prov_id
• attending_prov_id → ursa.no_ursa_core_prov_001.prov_id
• primary_hcpcs_proc_prov_id → ursa.no_ursa_core_prov_001.prov_id
• enc_id → ursa.so_ursa_core_enc_005.enc_id