Comparison of Medicaid Payments Relative to Medicare Using Inpatient Acute Care Claims from the Medicaid Program: Fiscal Year 2010-Fiscal Year 2011
| Autor: | Bridget Dickensheets, Devin A. Stone, John A. Poisal |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
media_common.quotation_subject Graduate medical education Medicare Fiscal year Insurance Claim Review 03 medical and health sciences 0302 clinical medicine Acute care Claims data medicine Humans 030212 general & internal medicine health care economics and organizations media_common Inpatients Actuarial science Medicaid 030503 health policy & services Health Policy Fee-for-Service Plans Length of Stay Payment United States Hospitalization Family medicine Medicaid and Marketplace Policies Medicaid Program Health Services Research Business Prospective payment system 0305 other medical science |
| Zdroj: | Health Services Research. 53:326-340 |
| ISSN: | 0017-9124 |
| DOI: | 10.1111/1475-6773.12645 |
| Popis: | Objective To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments. Data Sources Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer). Study Design Medicaid FFS inpatient hospital claims were run through Medicare's MS-DRG grouper and IPPS pricer to compare Medicaid's actual payment against what Medicare would have paid for the same claim. Principal Findings Average inpatient hospital claim payments for Medicaid were 68.8 percent of what Medicare would have paid in fiscal year 2010, and 69.8 percent in fiscal year 2011. Including Medicaid disproportionate share hospital (DSH), graduate medical education (GME), and supplemental payments reduces a substantial proportion of the gap between Medicaid and Medicare payments. Conclusions Medicaid payments relative to expected Medicare payments tend to be lower and vary by state Medicaid program, length of stay, and whether payments made outside of the Medicaid claims process are included. |
| Databáze: | OpenAIRE |
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