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Using Medicare cost reports to calculate costs for post-acute care claims

Citation

Coomer, N. M., Ingber, M., Coots, L. A., & Morley, M. (2017). Using Medicare cost reports to calculate costs for post-acute care claims. (RTI Press Publication No. OP-0036-1701). Research Triangle Park, NC: RTI Press. DOI: 10.3768/rtipress.2017.op.0036.1701

Abstract

This paper describes technical approaches for calculating costs associated with Medicare post-acute care provider claims including long-term care hospitals (LTCHs), inpatient rehabilitation facilities (IRFs), home health agencies (HHAs), and skilled nursing facilities (SNFs) using Medicare cost report data (Healthcare Cost Report Information System or HCRIS) and claims data. Costs of providing medical care, rather than payments for medical care, are often the focus of analyses of resource utilization. Calculated costs more accurately reflect the claim level costs to providers of providing care than the payments made to providers, which often include policy adjustments (such as disproportional share payments for inpatient hospitals) that are not directly related to the costs of providing care.

Author Details

Nicole Coomer

Nicole M. Coomer, PhD, is a senior economist at RTI International specializing in the analysis of health care payment systems. Her recent work focuses on the use of site-neutral payments in post-acute care (PAC) and risk- adjustment models to predict PAC episode payments and costs for the US Medicare program as well as the implementation of diagnosis-related groups for inpatient payment in Dubai. Dr. Coomer is a graduate of North Carolina State University, where she studied economics.

Melvin Ingber

Melvin J. Ingber, PhD, is a principal scientist at RTI International and was formerly director of the Division of Payment Research at Centers for Medicare & Medicaid Services (CMS). He has been doing research into modeling payment systems and quality measures for Medicare programs, both fee- for-service and managed care. Other recent work includes evaluating a CMS initiative to reduce avoidable hospitalizations for nursing facility residents.

Melissa Morley

Melissa Morley, PhD, is the deputy director of the Health Care Financing and Payment program at RTI International. She has more than 10 years of experience in health services and health policy research specializing in PAC episode utilization and payment, using Medicare claims and patient assessment data and savings calculations. Dr. Morley is a graduate of Tufts University; McMaster University, where she studied health economics and Canadian health policy as a Fulbright Scholar; and the Heller School for Social Policy and Management at Brandeis University.