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Hospice RIF¶

Source

https://www.resdac.org/cms-data/files/hospice-rif

Overview¶

The Hospice file contains final action claims submitted by Hospice providers. Once a beneficiary elects Hospice, all Hospice related claims will be found in this file, regardless if the beneficiary is in Medicare fee-for-service or in a Medicare managed care plan. This file includes:

the level of hospice care received (e.g., routine home care, inpatient respite care),
terminal diagnosis (ICD-9 diagnosis),
the dates of service,
reimbursement amounts,
Hospice 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¶

Hospice 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	`TOT_CHRG`	Claim Total Charge Amount	*	*
34	`PTNTSTUS`	NCH Patient Status Indicator Code		*
35	`UTIL_DAY`	Claim Utilization Day Count
36	`DSCHRGDT`	NCH Beneficiary Discharge Date
37	`PRNCPAL_DGNS_CD`	Claim Principal Diagnosis Code
38	`ICD_DGNS_CD1`	Claim Diagnosis Code I
39	`ICD_DGNS_CD2`	Claim Diagnosis Code II
40	`ICD_DGNS_CD3`	Claim Diagnosis Code III
41	`ICD_DGNS_CD4`	Claim Diagnosis Code IV
42	`ICD_DGNS_CD5`	Claim Diagnosis Code V
43	`ICD_DGNS_CD6`	Claim Diagnosis Code VI
44	`ICD_DGNS_CD7`	Claim Diagnosis Code VII
45	`ICD_DGNS_CD8`	Claim Diagnosis Code VIII
46	`ICD_DGNS_CD9`	Claim Diagnosis Code IX
47	`ICD_DGNS_CD10`	Claim Diagnosis Code X
48	`ICD_DGNS_CD11`	Claim Diagnosis Code XI
49	`ICD_DGNS_CD12`	Claim Diagnosis Code XII
50	`ICD_DGNS_CD13`	Claim Diagnosis Code XIII
51	`ICD_DGNS_CD14`	Claim Diagnosis Code XIV
52	`ICD_DGNS_CD15`	Claim Diagnosis Code XV
53	`ICD_DGNS_CD16`	Claim Diagnosis Code XVI
54	`ICD_DGNS_CD17`	Claim Diagnosis Code XVII
55	`ICD_DGNS_CD18`	Claim Diagnosis Code XVIII
56	`ICD_DGNS_CD19`	Claim Diagnosis Code XIX
57	`ICD_DGNS_CD20`	Claim Diagnosis Code XX
58	`ICD_DGNS_CD21`	Claim Diagnosis Code XXI
59	`ICD_DGNS_CD22`	Claim Diagnosis Code XXII
60	`ICD_DGNS_CD23`	Claim Diagnosis Code XXIII
61	`ICD_DGNS_CD24`	Claim Diagnosis Code XXIV
62	`ICD_DGNS_CD25`	Claim Diagnosis Code XXV
63	`FST_DGNS_E_CD`	First Claim Diagnosis E Code
64	`ICD_DGNS_E_CD1`	Claim Diagnosis E Code I
65	`ICD_DGNS_E_CD2`	Claim Diagnosis E Code II
66	`ICD_DGNS_E_CD3`	Claim Diagnosis E Code III
67	`ICD_DGNS_E_CD4`	Claim Diagnosis E Code IV
68	`ICD_DGNS_E_CD5`	Claim Diagnosis E Code V
69	`ICD_DGNS_E_CD6`	Claim Diagnosis E Code VI
70	`ICD_DGNS_E_CD7`	Claim Diagnosis E Code VII
71	`ICD_DGNS_E_CD8`	Claim Diagnosis E Code VIII
72	`ICD_DGNS_E_CD9`	Claim Diagnosis E Code IX
73	`ICD_DGNS_E_CD10`	Claim Diagnosis E Code X
74	`ICD_DGNS_E_CD11`	Claim Diagnosis E Code XI
75	`ICD_DGNS_E_CD12`	Claim Diagnosis E Code XII
76	`HSPCSTRT`	Claim Hospice Start Date
77	`HOSPCPRD`	Beneficiary's Hospice Period Count		*
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		*
86	`ACTIONCD`	FI or MAC Claim Action Code		*
87	`CLM_TRTMT_AUTHRZTN_NUM`	Claim Treatment Authorization Number		*
88	`CLM_PRCR_RTRN_CD`	Claim Pricer Return Code		*
89	`CLM_SRVC_FAC_ZIP_CD`	Claim service facility ZIP code (where service was provided)		*
90	`CLM_NEXT_GNRTN_ACO_IND_1_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population based payments (PBP)		*
91	`CLM_NEXT_GNRTN_ACO_IND_2_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth		*
92	`CLM_NEXT_GNRTN_ACO_IND_3_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits		*
93	`CLM_NEXT_GNRTN_ACO_IND_4_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3 day SNF waiver		*
94	`CLM_NEXT_GNRTN_ACO_IND_5_CD`	Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation		*
95	`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	`HCPCS_CD`	Revenue Center HCFA Common Procedure Coding System
9	`MDFR_CD1`	Revenue Center HCPCS Initial Modifier Code
10	`MDFR_CD2`	Revenue Center HCPCS Second Modifier Code
11	`MDFR_CD3`	HCPCS Third Modifier Code
12	`REV_UNIT`	Revenue Center Unit Count
13	`REV_RATE`	Revenue Center Rate Amount
14	`RPRVDPMT`	Revenue Center Provider Payment Amount
15	`RBENEPMT`	Revenue Center Beneficiary Payment Amount
16	`REVPMT`	Revenue Center Payment Amount
17	`REV_CHRG`	Revenue Center Total Charge Amount	*	*
18	`REV_NCVR`	Revenue Center Non-Covered Charge Amount		*
19	`REVDEDCD`	Revenue Center Deductible Coinsurance Code		*
20	`REV_CNTR_NDC_QTY`	Revenue Center NDC Quantity
21	`REV_CNTR_NDC_QTY_QLFR_CD`	Revenue Center NDC Quantity Qualifier Code		*
22	`RNDRNG_PHYSN_UPIN`	Revenue Center Rendering Physician UPIN
23	`RNDRNG_PHYSN_NPI`	Revenue Center Rendering Physician NPI
24	`RNDRNG_PHYSN_SPCLTY_CD`	Rendering Physician Specialty Code		*
25	`IDENDC`	Revenue Center IDE, NDC, or UPC Number
26	`REVSTIND`	Revenue Center Status Indicator Code		*
27	`REV_CNTR_PRCNG_IND_CD`	Revenue Center Pricing Indicator Code		*
28	`THRPY_CAP_IND_CD1`	Revenue Center Therapy Cap Indicator 1 Code		*
29	`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