Frequently Asked Questions

In the Inpatient Data, what is the difference between "Average Charges" and "Average Total Payments"?

"Average Charges" refers to what the provider bills to Medicare. "Average Total Payments" refers to what Medicare actually pays to the provider as well as co-payment and deductible amounts that the beneficiary is responsible for and payments by third parties for coordination of benefits.

Who pays the difference between what the provider charges and Medicare pays?

The provider has an agreement with Medicare to accept Medicare’s payment and the difference is not paid by Medicare or any other entity, including the beneficiary.

In the Inpatient Data, what is the "Total Payment" column?

The Total Payment amount includes the MS-DRG amount, bill total per diem, beneficiary primary payer claim payment amount, beneficiary Part A coinsurance amount, beneficiary deductible amount, beneficiary blood deducible amount and DRG outlier amount.