Outpatient LDS KnowledgeBase Articles

Discrepancy in the Outpatient Claim Payment Amount and Sum of the Revenue Center Payment Amounts

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Researchers working with the outpatient claims data are often interested in calculating the amount paid by Medicare for a particular claim. The total Medicare payment typically can be determined either by using the “Claim Payment Amount” (PMT_AMT) or by summing the “Revenue Center Payment Amount” (REVPMT) for each revenue center. However, researchers have found discrepancies in the amounts when comparing these two approaches.

Medicare MedPAR, Inpatient, Outpatient RIF and LDS files: “V” in the fifth position of the Provider Number

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Beginning in 2008, some hospital provider numbers appearing in the claims contain a “V” in the fifth position of the six-digit Medicare Provider Number. Usually, the fifth position is a number, not a character. These hospital provider numbers appear in the MedPAR, Inpatient and Outpatient files for both RIF and LDS versions.  ResDAC recommends that researchers remove these claims.

A Comparison of Medicare Limited Dataset Outpatient Files: Limited Data Set (LDS) Outpatient File, LDS Outpatient Prospective Payment System File (OPPS), and LDS Outpatient Prospective Payment System (OPPS) Partial Hospitalization Program File

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There are several types of claim-level files that contain outpatient claims; that is, facility claims submitted for care covered under Part B.  In this article, three versions of the LDS files are described:

  • Outpatient file,
  • Outpatient Prospective Payment System (OPPS) file, and
  • OPPS Partial Hospitalization file