For any medical visit for which a claim is submitted, we identify the intended, or suggested, "next" level of care by looking at the status code in box 17 from Medicare claim form UB-04 (CMS 1450).
We use this data to create counts of patients "Coded for..." different types of post-acute care throughout Marketscape. Locations where you will find this metric include:
- Explore page for facilities
- All Discharge Events by Setting tables on the Analyze page for facilities.
- Facility Sources table in the Home Health Analyze paqe
This coding is required for all Medicare Part A claims, which in Marketscape includes hospital inpatient, hospital outpatient, SNF, home health and hospice claims.
For inpatient stays these metrics provide an insight into the function and competence of the selected facility's discharge planning team. Facilities have different levels of maturity when it comes to coding, and these metrics will help you to identify facilities with more maturity and those that could use more help. For outpatient stays, the most used status code is 01 - which is essentially, go home, which implies that no subsequent admission to specific care is required or suggested. In the places where Outpatient metrics exist in Marketscape, the metrics are small, for this reason.
There are 99 codes available that can be used in this field. In Marketscape, we use the six post-acute care codes identified in the table below. ALL other codes are aggregated into the category, "Other."
|Post-Acute Destination||Status Code|
Coded for Inpatient Rehabilitation Facility (IRF)
|Coded for Long Term Care Hospitals (LTCH)||63|
|Coded for Home Health Agency (HHA)||06|
|Coded for Hospice (HOS)||40, 50,51|
|Coded for Skilled Nursing Facility (SNF)||03|
|Coded for Home or Self Care (No PAC)||blank, 0, 00, 01 (01 is the suggested code.)|
Based on the claims, there is no way to know whether a patient received any kind of guidance about post-acute care at the time of discharge, nor can we determine the nature of any instructions provided. Status coding is only about what was reported on the form.
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