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Inpatient RIF

Source

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

Overview

The Inpatient file contains final action fee-for-service claims data submitted by inpatient hospital providers for reimbursement of facility charges. The charge amount can be broken out for specific Revenue Center Codes, such as those for emergency room or emergency department charges.

This file includes:

  • diagnosis (ICD-9 diagnosis),
  • procedure (ICD-9 procedure code),
  • Medicare Severity Diagnosis Related Group (MS-DRG),
  • dates of service,
  • reimbursement amount,
  • hospital provider number, and
  • beneficiary demographic information

Additionally, this file includes revenue center information. The Revenue Center Codes provide details on charges, such as those for emergency room/emergency department charges.

Why do researchers request this file?

  • Clinical outcome studies that require diagnosis and procedure codes or length of hospital stay
  • Evaluations of cost, including charges and Medicare program payments
  • Analysis of specific service utilization by charge amount, such as emergency room use
  • Need to link IP data to other utilization file types and enrollment data

Emergency room and Emergency department facility costs and facility charges are available in this file.

Availability: CY 1999 - 2015

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

Data Documentation

Inpatient 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 QUERY_CD Claim Query Code *
10 PROVIDER Provider Number *
11 FAC_TYPE Claim Facility Type Code *
12 TYPESRVC Claim Service Classification Type Code *
13 FREQ_CD Claim Frequency Code *
14 FI_NUM FI Number *
15 NOPAY_CD Claim Medicare Non Payment Reason Code *
16 PMT_AMT Claim Payment Amount *
17 PRPAYAMT NCH Primary Payer Claim Paid Amount*
18 PRPAY_CD NCH Primary Payer Code *
19 ACTIONCD FI or MAC Claim Action Code *
20 PRSTATE NCH Provider State Code *
21 ORGNPINM Organization NPI Number
22 AT_UPIN Claim Attending Physician UPIN Number
23 AT_NPI Claim Attending Physician NPI Number
24 AT_PHYSN_SPCLTY_CD Claim Attending Physician Specialty Code *
25 OP_UPIN Claim Operating Physician UPIN Number
26 OP_NPI Claim Operating Physician NPI Number
27 OP_PHYSN_SPCLTY_CD Claim Operating Physician Specialty Code *
28 OT_UPIN Claim Other Physician UPIN Number
29 OT_NPI Claim Other Physician NPI Number
30 OT_PHYSN_SPCLTY_CD Claim Other Physician Specialty Code *
31 RNDRNG_PHYSN_NPI Claim Rendering Physician NPI Number
32 RNDRNG_PHYSN_SPCLTY_CD Claim Rendering Physician Specialty Code *
33 MCOPDSW Claim MCO Paid Switch * *
34 STUS_CD Patient Discharge Status Code *
35 PPS_IND Claim PPS Indicator Code *
36 TOT_CHRG Claim Total Charge Amount * *
37 ADMSN_DT Claim Admission Date
38 TYPE_ADM Claim Inpatient Admission Type Code *
39 SRC_ADMS Claim Source Inpatient Admission Code *
40 PTNTSTUS NCH Patient Status Indicator Code *
41 PER_DIEM Claim Pass Thru Per Diem Amount
42 DED_AMT NCH Beneficiary Inpatient Deductible Amount *
43 COIN_AMT NCH Beneficiary Part A Coinsurance Liability Amount *
44 BLDDEDAM NCH Beneficiary Blood Deductible Liability Amount *
45 PCCHGAMT NCH Professional Component Charge Amount *
46 NCCHGAMT NCH Inpatient Noncovered Charge Amount *
47 TDEDAMT NCH Inpatient Total Deduction Amount *
48 PPS_CPTL Claim Total PPS Capital Amount *
49 CPTL_FSP Claim PPS Capital FSP Amount *
50 CPTLOUTL Claim PPS Capital Outlier Amount *
51 DISP_SHR Claim PPS Capital Disproportionate Share Amount
52 IME_AMT Claim PPS Capital IME Amount
53 CPTL_EXP Claim PPS Capital Exception Amount *
54 HLDHRMLS Claim PPS Old Capital Hold Harmless Amount
55 DRGWTAMT Claim PPS Capital DRG Weight Number *
56 UTIL_DAY Claim Utilization Day Count
57 COIN_DAY Beneficiary Total Coinsurance Days Count
58 LRD_USE Beneficiary LRD Used Count
59 NUTILDAY Claim Non Utilization Days Count
60 BLDFRNSH NCH Blood Pints Furnished Quantity
61 NCOVFROM NCH Verified Noncovered Stay From Date
62 NCOVTHRU NCH Verified Noncovered Stay Through Date
63 CARETHRU NCH Active or Covered Level Care Thru Date
64 EXHST_DT NCH Beneficiary Medicare Benefits Exhausted Date
65 DSCHRGDT NCH Beneficiary Discharge Date
66 DRG_CD Claim Diagnosis Related Group Code
67 OUTLR_CD Claim Diagnosis Related Group Outlier Stay Code *
68 OUTLRPMT NCH DRG Outlier Approved Payment Amount
69 ADMTG_DGNS_CD Claim Admitting Diagnosis Code
70 PRNCPAL_DGNS_CD Claim Principal Diagnosis Code
71 ICD_DGNS_CD1 Claim Diagnosis Code I
72 CLM POA IND SW1 Claim Diagnosis Code I Diagnosis Present on Admission Indicator Code * *
73 ICD_DGNS_CD2 Claim Diagnosis Code II
74 CLM POA IND SW2 Claim Diagnosis Code II Diagnosis Present on Admission Indicator Code *
75 ICD_DGNS_CD3 Claim Diagnosis Code III
76 CLM POA IND SW3 Claim Diagnosis Code III Diagnosis Present on Admission Indicator Code *
77 ICD_DGNS_CD4 Claim Diagnosis Code IV
78 CLM POA IND SW4 Claim Diagnosis Code IV Diagnosis Present on Admission Indicator Code *
79 ICD_DGNS_CD5 Claim Diagnosis Code V
80 CLM POA IND SW5 Claim Diagnosis Code V Diagnosis Present on Admission Indicator Code *
81 ICD_DGNS_CD6 Claim Diagnosis Code VI
82 CLM POA IND SW6 Claim Diagnosis Code VI Diagnosis Present on Admission Indicator Code *
83 ICD_DGNS_CD7 Claim Diagnosis Code VII
84 CLM POA IND SW7 Claim Diagnosis Code VII Diagnosis Present on Admission Indicator Code *
85 ICD_DGNS_CD8 Claim Diagnosis Code VIII
86 CLM POA IND SW8 Claim Diagnosis Code VIII Diagnosis Present on Admission Indicator Code *
87 ICD_DGNS_CD9 Claim Diagnosis Code IX
88 CLM POA IND SW9 Claim Diagnosis Code IX Diagnosis Present on Admission Indicator Code *
89 ICD_DGNS_CD10 Claim Diagnosis Code X
90 CLM POA IND SW10 Claim Diagnosis Code X Diagnosis Present on Admission Indicator Code *
91 ICD_DGNS_CD11 Claim Diagnosis Code XI
92 CLM POA IND SW11 Claim Diagnosis Code XI Diagnosis Present on Admission Indicator Code *
93 ICD_DGNS_CD12 Claim Diagnosis Code XII
94 CLM POA IND SW12 Claim Diagnosis Code XII Diagnosis Present on Admission Indicator Code *
95 ICD_DGNS_CD13 Claim Diagnosis Code XIII
96 CLM POA IND SW13 Claim Diagnosis Code XIII Diagnosis Present on Admission Indicator Code *
97 ICD_DGNS_CD14 Claim Diagnosis Code XIV
98 CLM POA IND SW14 Claim Diagnosis Code XIV Diagnosis Present on Admission Indicator Code *
99 ICD_DGNS_CD15 Claim Diagnosis Code XV
100 CLM POA IND SW15 Claim Diagnosis Code XV Diagnosis Present on Admission Indicator Code *
101 ICD_DGNS_CD16 Claim Diagnosis Code XVI
102 CLM POA IND SW16 Claim Diagnosis Code XVI Diagnosis Present on Admission Indicator Code *
103 ICD_DGNS_CD17 Claim Diagnosis Code XVII
104 CLM POA IND SW17 Claim Diagnosis Code XVII Diagnosis Present on Admission Indicator Code *
105 ICD_DGNS_CD18 Claim Diagnosis Code XVIII
106 CLM POA IND SW18 Claim Diagnosis Code XVIII Diagnosis Present on Admission Indicator Code *
107 ICD_DGNS_CD19 Claim Diagnosis Code XIX
108 CLM POA IND SW19 Claim Diagnosis Code XIX Diagnosis Present on Admission Indicator Code *
109 ICD_DGNS_CD20 Claim Diagnosis Code XX
110 CLM POA IND SW20 Claim Diagnosis Code XX Diagnosis Present on Admission Indicator Code *
111 ICD_DGNS_CD21 Claim Diagnosis Code XXI
112 CLM POA IND SW21 Claim Diagnosis Code XXI Diagnosis Present on Admission Indicator Code *
113 ICD_DGNS_CD22 Claim Diagnosis Code XXII
114 CLM POA IND SW22 Claim Diagnosis Code XXII Diagnosis Present on Admission Indicator Code *
115 ICD_DGNS_CD23 Claim Diagnosis Code XXIII
116 CLM POA IND SW23 Claim Diagnosis Code XXIII Diagnosis Present on Admission Indicator Code *
117 ICD_DGNS_CD24 Claim Diagnosis Code XXIV
118 CLM POA IND SW24 Claim Diagnosis Code XXIV Diagnosis Present on Admission Indicator Code *
119 ICD_DGNS_CD25 Claim Diagnosis Code XXV
120 CLM POA IND SW25 Claim Diagnosis Code XXV Diagnosis Present on Admission Indicator Code *
121 FST_DGNS_E_CD First Claim Diagnosis E Code
122 ICD_DGNS_E_CD1 Claim Diagnosis E Code I
123 CLM E POA IND SW1 Claim Diagnosis E Code I Diagnosis Present on Admission Indicator Code *
124 ICD_DGNS_E_CD2 Claim Diagnosis E Code II
125 CLM E POA IND SW2 Claim Diagnosis E Code II Diagnosis Present on Admission Indicator Code *
126 ICD_DGNS_E_CD3 Claim Diagnosis E Code III
127 CLM E POA IND SW3 Claim Diagnosis E Code III Diagnosis Present on Admission Indicator Code *
128 ICD_DGNS_E_CD4 Claim Diagnosis E Code IV
129 CLM E POA IND SW4 Claim Diagnosis E Code IV Diagnosis Present on Admission Indicator Code *
130 ICD_DGNS_E_CD5 Claim Diagnosis E Code V
131 CLM E POA IND SW5 Claim Diagnosis E Code V Diagnosis Present on Admission Indicator Code *
132 ICD_DGNS_E_CD6 Claim Diagnosis E Code VI
133 CLM E POA IND SW6 Claim Diagnosis E Code VI Diagnosis Present on Admission Indicator Code *
134 ICD_DGNS_E_CD7 Claim Diagnosis E Code VII
135 CLM E POA IND SW7 Claim Diagnosis E Code VII Diagnosis Present on Admission Indicator Code *
136 ICD_DGNS_E_CD8 Claim Diagnosis E Code VIII
137 CLM E POA IND SW8 Claim Diagnosis E Code VIII Diagnosis Present on Admission Indicator Code *
138 ICD_DGNS_E_CD9 Claim Diagnosis E Code IX
139 CLM E POA IND SW9 Claim Diagnosis E Code IX Diagnosis Present on Admission Indicator Code *
140 ICD_DGNS_E_CD10 Claim Diagnosis E Code X
141 CLM E POA IND SW10 Claim Diagnosis E Code X Diagnosis Present on Admission Indicator Code *
142 ICD_DGNS_E_CD11 Claim Diagnosis E Code XI
143 CLM E POA IND SW11 Claim Diagnosis E Code XI Diagnosis Present on Admission Indicator Code *
144 ICD_DGNS_E_CD12 Claim Diagnosis E Code XII
145 CLM E POA IND SW12 Claim Diagnosis E Code XII Diagnosis Present on Admission Indicator Code *
146 ICD_PRCDR_CD1 Claim Procedure Code I
147 PRCDR_DT1 Claim Procedure Code I Date
148 ICD_PRCDR_CD2 Claim Procedure Code II
149 PRCDR_DT2 Claim Procedure Code II Date
150 ICD_PRCDR_CD3 Claim Procedure Code III
151 PRCDR_DT3 Claim Procedure Code III Date
152 ICD_PRCDR_CD4 Claim Procedure Code IV
153 PRCDR_DT4 Claim Procedure Code IV Date
154 ICD_PRCDR_CD5 Claim Procedure Code V
155 PRCDR_DT5 Claim Procedure Code V Date
156 ICD_PRCDR_CD6 Claim Procedure Code VI
157 PRCDR_DT6 Claim Procedure Code VI Date
158 ICD_PRCDR_CD7 Claim Procedure Code VII
159 PRCDR_DT7 Claim Procedure Code VII Date
160 ICD_PRCDR_CD8 Claim Procedure Code VIII
161 PRCDR_DT8 Claim Procedure Code VIII Date
162 ICD_PRCDR_CD9 Claim Procedure Code IX
163 PRCDR_DT9 Claim Procedure Code IX Date
164 ICD_PRCDR_CD10 Claim Procedure Code X
165 PRCDR_DT10 Claim Procedure Code X Date
166 ICD_PRCDR_CD11 Claim Procedure Code XI
167 PRCDR_DT11 Claim Procedure Code XI Date
168 ICD_PRCDR_CD12 Claim Procedure Code XII
169 PRCDR_DT12 Claim Procedure Code XII Date
170 ICD_PRCDR_CD13 Claim Procedure Code XIII
171 PRCDR_DT13 Claim Procedure Code XIII Date
172 ICD_PRCDR_CD14 Claim Procedure Code XIV
173 PRCDR_DT14 Claim Procedure Code XIV Date
174 ICD_PRCDR_CD15 Claim Procedure Code XV
175 PRCDR_DT15 Claim Procedure Code XV Date
176 ICD_PRCDR_CD16 Claim Procedure Code XVI
177 PRCDR_DT16 Claim Procedure Code XVI Date
178 ICD_PRCDR_CD17 Claim Procedure Code XVII
179 PRCDR_DT17 Claim Procedure Code XVII Date
180 ICD_PRCDR_CD18 Claim Procedure Code XVIII
181 PRCDR_DT18 Claim Procedure Code XVIII Date
182 ICD_PRCDR_CD19 Claim Procedure Code XIX
183 PRCDR_DT19 Claim Procedure Code XIX Date
184 ICD_PRCDR_CD20 Claim Procedure Code XX
185 PRCDR_DT20 Claim Procedure Code XX Date
186 ICD_PRCDR_CD21 Claim Procedure Code XXI
187 PRCDR_DT21 Claim Procedure Code XXI Date
188 ICD_PRCDR_CD22 Claim Procedure Code XXII
189 PRCDR_DT22 Claim Procedure Code XXII Date
190 ICD_PRCDR_CD23 Claim Procedure Code XXIII
191 PRCDR_DT23 Claim Procedure Code XXIII Date
192 ICD_PRCDR_CD24 Claim Procedure Code XXIV
193 PRCDR_DT24 Claim Procedure Code XXIV Date
194 ICD_PRCDR_CD25 Claim Procedure Code XXV
195 PRCDR_DT25 Claim Procedure Code XXV Date
196 IME_OP Operating Indirect Medical Education (IME) Amount*
197 DSH_OP Operating Disproportionate Share Amount* *
198 DOB_DT Date of Birth from Claim (Date)
199 GNDR_CD Gender Code from Claim *
200 RACE_CD Race Code from Claim *
201 CNTY_CD County Code from Claim (SSA)
202 STATE_CD State Code from Claim (SSA) *
203 ZIP_CD Zip Code of Residence from Claim
204 CLM_MDCL_REC Claim Medical Record Number
205 CLM_TRTMT_AUTHRZTN_NUM Claim Treatment Authorization Number *
206 CLM_PRCR_RTRN_CD Claim Pricer Return Code *
207 CLM_SRVC_FAC_ZIP_CD Claim service facility ZIP code (where service was provided) *
208 CLM_IP_LOW_VOL_PMT_AMT Claim Inpatient Low Volume Payment Amount *
209 CLM_CARE_IMPRVMT_MODEL_CD1 Claim Care Improvement Model 1 Code (bundled payment) *
210 CLM_CARE_IMPRVMT_MODEL_CD2 Claim Care Improvement Model 2 Code *
211 CLM_CARE_IMPRVMT_MODEL_CD3 Claim Care Improvement Model 3 Code *
212 CLM_CARE_IMPRVMT_MODEL_CD4 Claim Care Improvement Model 4 Code *
213 CLM_BNDLD_MODEL_1_DSCNT_PCT Claim Bundled Model 1 Discount Percent *
214 CLM_BASE_OPRTG_DRG_AMT Claim Base Operating DRG Amount
215 CLM_VBP_PRTCPNT_IND_CD Claim Value-Based Purchasing (VBP) Participant Indicator Code *
216 CLM_VBP_ADJSTMT_PCT Claim VBP Adjustment Percent *
217 CLM_HRR_PRTCPNT_IND_CD Claim Hospital Readmission Reduction (HRR) Participant Indicator Code *
218 CLM_HRR_ADJSTMT_PCT Claim HRR Adjustment Percent *
219 CLM_MODEL_4_READMSN_IND_CD Claim Model 4 Readmission Indicator Code *
220 CLM_UNCOMPD_CARE_PMT_AMT Claim Uncompensated Care Payment Amount *
221 CLM_BNDLD_ADJSTMT_PMT_AMT Claim Bundled Adjustment Payment Amount *
222 CLM_VBP_ADJSTMT_PMT_AMT Claim Value Based Purchasing Adjustment Payment Amount *
223 CLM_HRR_ADJSTMT_PMT_AMT Claim Hospital Readmission Reduction (HRR) Adjustment Payment Amount *
224 EHR_PYMT_ADJSTMT_AMT Claim Electronic Health Record (EHR) Payment Adjustment Amount *
225 PPS_STD_VAL_PYMT_AMT Standard Payment Amount *
226 FINL_STD_AMT Claim Final Standard Payment Amount *
227 HAC_PGM_RDCTN_IND_SW Claim Hospital Acquired Condition (HAC) Program Reduction Indicator Switch *
228 EHR_PGM_RDCTN_IND_SW Claim Electronic Health Records (EHR) Program Reduction Indicator Switch *
229 CLM_SITE_NTRL_PYMT_CST_AMT Claim Site Neutral Payment Based on Cost Amount *
230 CLM_SITE_NTRL_PYMT_IPPS_AMT Claim Site Neutral Payment Based on inpatient prospective payment system (IPPS) Amounts *
231 CLM_FULL_STD_PYMT_AMT Claim Full Standard Payment Amount *
232 CLM_SS_OUTLIER_STD_PYMT_AMT Claim Short Stay Outlier (SSO) Standard Payment Amount *
233 CLM_NEXT_GNRTN_ACO_IND_1_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Population based payments (PBP) *
234 CLM_NEXT_GNRTN_ACO_IND_2_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Telehealth *
235 CLM_NEXT_GNRTN_ACO_IND_3_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Post Discharge HH visits *
236 CLM_NEXT_GNRTN_ACO_IND_4_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - 3 day SNF waiver *
237 CLM_NEXT_GNRTN_ACO_IND_5_CD Claim Next Generation (NG) Accountable Care Organization (ACO) Indicator Code - Capitation *
238 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 HCPCS_CD Revenue Center HCFA Common Procedure Coding System
8 MDFR_CD1 Revenue Center HCPCS Initial Modifier Code
9 MDFR_CD2 Revenue Center HCPCS Second Modifier Code
10 MDFR_CD3 HCPCS Third Modifier Code
11 REV_UNIT Revenue Center Unit Count
12 REV_RATE Revenue Center Rate Amount
13 REV_CHRG Revenue Center Total Charge Amount * *
14 REV_NCVR Revenue Center Non-Covered Charge Amount *
15 REVDEDCD Revenue Center Deductible Coinsurance Code *
16 REV_CNTR_NDC_QTY Revenue Center NDC Quantity
17 REV_CNTR_NDC_QTY_QLFR_CD Revenue Center NDC Quantity Qualifier Code *
18 RNDRNG_PHYSN_UPIN Revenue Center Rendering Physician UPIN
19 RNDRNG_PHYSN_NPI Revenue Center Rendering Physician NPI
20 RNDRNG_PHYSN_SPCLTY_CD Rendering Physician Specialty Code *
21 IDENDC Revenue Center IDE, NDC, or UPC Number
22 REV_CNTR_PRCNG_IND_CD Revenue Center Pricing Indicator Code *
23 THRPY_CAP_IND_CD1 Revenue Center Therapy Cap Indicator 1 Code *
24 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 *

Occurrence 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