URSA-PHF-052: SNF Encounter Average Plan Paid

Measure Description

Among skilled nursing facility (SNF) encounters, the average plan paid amount for the full encounter.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Normal-Form
• Denominator Case Field: Encounter ID
• Target Direction: Down

Denominator Description

One per skilled nursing facility encounter; excludes SNF encounters that do not yet have a discharge date.

Numerator Description

The total plan paid amount for the encounter.

Published Fields

• Data Model Keys

  • Encounter ID
  • Patient ID
  • Encounter Primary Payor ID
  • Encounter Primary Plan ID
  • Facility Provider ID
  • Attending Provider ID

• Date Fields

  • Encounter Start Date
  • Encounter End Date
  • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
  • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)

• Encounter Fields

  • 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

• Provider Fields

  • Facility Provider Description
  • Facility 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

• 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

• Billing and Claims Fields

  • MS-DRG Code
  • MS-DRG Description
  • MS-DRG MDC Code
  • MS-DRG MDC Description
  • CMS Admit Source Code
  • CMS Admit Source Description
  • CMS Admit Type Code
  • CMS Admission Type Description
  • CMS Patient Discharge Status Code
  • CMS Patient Discharge Status Description

• Financial Fields

  • Total Plan Paid Amount from All Plans
  • Primary Plan Paid Amount
  • Primary Plan Allowed Amount
  • Patient Paid Amount
  • 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

• Measure Fields

  • Denominator
  • Numerator