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Home Health Agency RIF¶

Source

https://www.resdac.org/cms-data/files/hha-encounter

Overview¶

The Home Health Agency (HHA) file contains final action, fee-for-service claims submitted by HHA providers. This file includes:

the number of visits,
type of visit (skilled-nursing care, home health aides, physical therapy, speech therapy, occupational therapy, and medical social services),
diagnosis (ICD-9 diagnosis),
the dates of visits,
reimbursement amount,
HHA provider number, and
beneficiary demographic information.

Availability: CY 1999 - 2015

The 12-month run-off final action claims for 2016 will be available in the beginning of 2018.

Data Documentation¶

Home Health Agency RIF¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`RIC_CD`	NCH Near Line Record Identification Code		*
4	`CLM_TYPE`	NCH Claim Type Code		*
5	`FROM_DT`	Claim From Date
6	`THRU_DT`	Claim Through Date
7	`WKLY_DT`	NCH Weekly Claim Processing Date
8	`FI_CLM_PROC_DT`	FI Claim Process Date
9	`PROVIDER`	Provider Number		*
10	`FAC_TYPE`	Claim Facility Type Code		*
11	`TYPESRVC`	Claim Service Classification Type Code		*
12	`FREQ_CD`	Claim Frequency Code		*
13	`FI_NUM`	FI Number		*
14	`NOPAY_CD`	Claim Medicare Non Payment Reason Code		*
15	`PMT_AMT`	Claim Payment Amount	*
16	`PRPAYAMT`	NCH Primary Payer Claim Paid Amount*
17	`PRPAY_CD`	NCH Primary Payer Code		*
18	`PRSTATE`	NCH Provider State Code		*
19	`ORGNPINM`	Organization NPI Number
20	`SRVC_LOC_NPI_NUM`	Claim Service Location NPI Number
21	`AT_UPIN`	Claim Attending Physician UPIN Number
22	`AT_NPI`	Claim Attending Physician NPI Number
23	`AT_PHYSN_SPCLTY_CD`	Claim Attending Physician Specialty Code		*
24	`OP_NPI`	Claim Operating Physician NPI Number
25	`OP_PHYSN_SPCLTY_CD`	Claim Operating Physician Specialty Code		*
26	`OT_NPI`	Claim Other Physician NPI Number
27	`OT_PHYSN_SPCLTY_CD`	Claim Other Physician Specialty Code		*
28	`RNDRNG_PHYSN_NPI`	Claim Rendering Physician NPI Number
29	`RNDRNG_PHYSN_SPCLTY_CD`	Claim Rendering Physician Specialty Code		*
30	`RFR_PHYSN_NPI`	Claim Referring Physician NPI Number
31	`RFR_PHYSN_SPCLTY_CD`	Claim Referring Physician Specialty Code		*
32	`STUS_CD`	Patient Discharge Status Code		*
33	`PPS_IND`	Claim PPS Indicator Code		*
34	`TOT_CHRG`	Claim Total Charge Amount	*	*
35	`PRNCPAL_DGNS_CD`	Claim Principal Diagnosis Code
36	`ICD_DGNS_CD1`	Claim Diagnosis Code I
37	`ICD_DGNS_CD2`	Claim Diagnosis Code II
38	`ICD_DGNS_CD3`	Claim Diagnosis Code III
39	`ICD_DGNS_CD4`	Claim Diagnosis Code IV
40	`ICD_DGNS_CD5`	Claim Diagnosis Code V
41	`ICD_DGNS_CD6`	Claim Diagnosis Code VI
42	`ICD_DGNS_CD7`	Claim Diagnosis Code VII
43	`ICD_DGNS_CD8`	Claim Diagnosis Code VIII
44	`ICD_DGNS_CD9`	Claim Diagnosis Code IX
45	`ICD_DGNS_CD10`	Claim Diagnosis Code X
46	`ICD_DGNS_CD11`	Claim Diagnosis Code XI
47	`ICD_DGNS_CD12`	Claim Diagnosis Code XII
48	`ICD_DGNS_CD13`	Claim Diagnosis Code XIII
49	`ICD_DGNS_CD14`	Claim Diagnosis Code XIV
50	`ICD_DGNS_CD15`	Claim Diagnosis Code XV
51	`ICD_DGNS_CD16`	Claim Diagnosis Code XVI
52	`ICD_DGNS_CD17`	Claim Diagnosis Code XVII
53	`ICD_DGNS_CD18`	Claim Diagnosis Code XVIII
54	`ICD_DGNS_CD19`	Claim Diagnosis Code XIX
55	`ICD_DGNS_CD20`	Claim Diagnosis Code XX
56	`ICD_DGNS_CD21`	Claim Diagnosis Code XXI
57	`ICD_DGNS_CD22`	Claim Diagnosis Code XXII
58	`ICD_DGNS_CD23`	Claim Diagnosis Code XXIII
59	`ICD_DGNS_CD24`	Claim Diagnosis Code XXIV
60	`ICD_DGNS_CD25`	Claim Diagnosis Code XXV
61	`FST_DGNS_E_CD`	First Claim Diagnosis E Code
62	`ICD_DGNS_E_CD1`	Claim Diagnosis E Code I
63	`ICD_DGNS_E_CD2`	Claim Diagnosis E Code II
64	`ICD_DGNS_E_CD3`	Claim Diagnosis E Code III
65	`ICD_DGNS_E_CD4`	Claim Diagnosis E Code IV
66	`ICD_DGNS_E_CD5`	Claim Diagnosis E Code V
67	`ICD_DGNS_E_CD6`	Claim Diagnosis E Code VI
68	`ICD_DGNS_E_CD7`	Claim Diagnosis E Code VII
69	`ICD_DGNS_E_CD8`	Claim Diagnosis E Code VIII
70	`ICD_DGNS_E_CD9`	Claim Diagnosis E Code IX
71	`ICD_DGNS_E_CD10`	Claim Diagnosis E Code X
72	`ICD_DGNS_E_CD11`	Claim Diagnosis E Code XI
73	`ICD_DGNS_E_CD12`	Claim Diagnosis E Code XII
74	`LUPAIND`	Claim HHA Low Utilization Payment Adjustment (LUPA) Indicator Code	*	*
75	`HHA_RFRL`	Claim HHA Referral Code	*	*
76	`VISITCNT`	Claim HHA Total Visit Count	*
77	`HHSTRTDT`	Claim HHA Care Start Date
78	`DOB_DT`	Date of Birth from Claim (Date)
79	`GNDR_CD`	Gender Code from Claim		*
80	`RACE_CD`	Race Code from Claim		*
81	`CNTY_CD`	County Code from Claim (SSA)
82	`STATE_CD`	State Code from Claim (SSA)		*
83	`ZIP_CD`	Zip Code of Residence from Claim
84	`CLM_MDCL_REC`	Claim Medical Record Number
85	`QUERY_CD`	Claim Query Code		*
97	`ACO_ID_NUM`	Claim Accountable Care Organization (ACO) Identification Number

Revenue Center File¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`THRU_DT`	Claim Through Date
4	`CLM_LN`	Claim Line Number
5	`CLM_TYPE`	NCH Claim Type Code		*
6	`REV_CNTR`	Revenue Center Code		*
7	`REV_DT`	Revenue Center Date
8	`REVANSI1`	Revenue Center 1^st ANSI Code		*
9	`APCHIPPS`	Revenue Center APC/HIPPS		*
10	`HCPCS_CD`	Revenue Center HCFA Common Procedure Coding System
11	`MDFR_CD1`	Revenue Center HCPCS Initial Modifier Code
12	`MDFR_CD2`	Revenue Center HCPCS Second Modifier Code
13	`MDFR_CD3`	HCPCS Third Modifier Code
14	`PMTMTHD`	Revenue Center Payment Method Indicator Code		*
15	`REV_UNIT`	Revenue Center Unit Count
16	`REV_RATE`	Revenue Center Rate Amount
17	`REVPMT`	Revenue Center Payment Amount
18	`REV_CHRG`	Revenue Center Total Charge Amount	*	*
19	`REV_NCVR`	Revenue Center Non-Covered Charge Amount		*
20	`REVDEDCD`	Revenue Center Deductible Coinsurance Code		*
21	`REVSTIND`	Revenue Center Status Indicator Code		*
22	`REV_CNTR_NDC_QTY`	Revenue Center NDC Quantity
23	`REV_CNTR_NDC_QTY_QLFR_CD`	Revenue Center NDC Quantity Qualifier Code		*
24	`RNDRNG_PHYSN_UPIN`	Revenue Center Rendering Physician UPIN
25	`RNDRNG_PHYSN_NPI`	Revenue Center Rendering Physician NPI
26	`RNDRNG_PHYSN_SPCLTY_CD`	Rendering Physician Specialty Code		*
27	`DSCNTIND`	Revenue Center Discount Indicator Code		*
28	`IDENDC`	Revenue Center IDE, NDC, or UPC Number
29	`RPRVDPMT`	Revenue Center (Medicare) Provider Payment Amount
30	`PTNTRESP`	Revenue Center Patient Responsibility Payment Amount		*
31	`REV_CNTR_PRCNG_IND_CD`	Revenue Center Pricing Indicator Code		*
32	`THRPY_CAP_IND_CD1`	Revenue Center Therapy Cap Indicator 1 Code		*
33	`THRPY_CAP_IND_CD2`	Revenue Center Therapy Cap Indicator 2 Code		*

Condition Code File¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`CLM_TYPE`	NCH Claim Type Code		*
4	`RLTCNDSQ`	Claim Related Condition Code Sequence
5	`RLT_COND`	Claim Related Condition Code		*

Occurence Code File¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`CLM_TYPE`	NCH Claim Type Code		*
4	`RLTOCRSQ`	Claim Related Occurrence Code Sequence
5	`OCRNC_CD`	Claim Related Occurrence Code		*
6	`OCRNCDT`	Claim Related Occurrence Date

Span Code File¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`CLM_TYPE`	NCH Claim Type Code		*
4	`RLTSPNSQ`	Claim Related Span Code Sequence
5	`SPAN_CD`	Claim Occurrence Span Code		*
6	`SPANFROM`	Claim Occurrence Span From Date
7	`SPANTHRU`	Claim Occurrence Span Through Date

Value Code File¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`CLM_TYPE`	NCH Claim Type Code		*
4	`RLTVALSQ`	Claim Related Value Code Sequence
5	`VAL_CD`	Claim Value Code		*
6	`VAL_AMT`	Claim Value Amount		*

Demonstrations/Innovations Code File¶

Index	SAS Name	Variable Name	Limitation	Code Table
1	`BENE_ID`	Encrypted CCW Beneficiary ID
2	`CLM_ID`	Claim ID	*
3	`CLM_TYPE`	NCH Claim Type Code		*
4	`DEMO_ID_SQNC_NUM`	Demonstration sequence number
5	`DEMO_ID_NUM`	Demonstration number		*
6	`DEMO_INFO_TXT`	Demo information text