It is important to understand the difference between Facility Type and Claim Type as they are presented in Marketscape. For example, on the Explore page, you can see filters and columns for each. You can sort or filter by either column, or both. This article is designed to help you to understand the results you will get for the choices you make.
We get our facility types from the NPI NPPES registry, which includes the primary taxonomy given to a provider when registering for an NPI. See the image below for an example.
The image for the full page has not been included; only the content relevant for this example, From this image, we would apply the facility type, "Home Health."
The following list is a sample of the facility types that might be found in Marketscape:
If there are no claims in a specific dataset for a specific facility type, that facility type will not appear in Marketscape.
All data that we receive from CMS is organized into the following claim types
- Home Health
- Skilled Nursing (SNF)
These are determined by the Bill Type code submitted in Box FL4 from CMS form 1450 (UB-04).
What's the mix up?
In Marketscape, we match the data we receive from CMS that is organized by claim type by NPI to providers that are organized by facility type.
Most of the results will make sense.
For example, a provider with the facility type General Acute Care Hospital - a hospital - will have claim types Inpatient and Outpatient.
But what happens if a Skilled Nursing Facility submits claims for Outpatient? Or if a hospital submits a SNF claim?
Let's look at some of these claim types:
For a hospital, an inpatient claim applies to the enormous spectrum of treatments and care for a patient whose condition requires an overnight stay in a hospital. Although there are some exceptions, just think, "acute care needed and admitted to a hospital by a physician."
There are also a handful of inpatient claims that might be submitted by a home health agency.
Normally, when we think of outpatient, we envision a patient going to a hospital for a procedure that doesn't require an overnight stay. Outpatient claims can apply to other facility types as shown in this table:
Type of Care
Outpatient services rendered in a hospital setting:
Skilled Nursing Facility
Outpatient care provided by a SNF:
Very limited Outpatient claims. Typically for osteoporosis drugs.
No documented Outpatient claims for NPIs who identify as a Hospice
ESRD, FQHC, RHC, CMHC, Laboratory services for non-patients, Part B services for patients that have exhausted Part A coverage
Any skilled nursing service that can only be carried out by medical professionals in either a hospital (swing bed) or Skilled Nursing Facility setting. Although there are numerous requirements, limitations, and restrictions, the following list includes a partial list of services:
- A room, with meals and basic needs
- Skilled nursing care
- Therapy - OT, PT, SLT
- Medications and medical supplies
- This is not an exhaustive list but is provided as an example of the types of services
The enormous amount of the time, home health claims will only be submitted by home health facilities, but there are rare exceptions to this.
Because of the nature of hospice, all hospice claims will be submitted by hospices, and only hospices will submit hospice claims.
Where can I find different claim types?
Claim type is a metric that has its own column in the Explore page table for Facilities (Hospitals and Agencies in Marketscape for SNF). There is also a filter that allows you to limit the entries in the table to a single claim type or a combination of claim types.
Remember that Claim type and Facility type in the filters are referring to different things. For example, under Facility type you will find about 40 different facility types. Claim types will include the five you see in the image above. The claim type is specified for us
Throughout the rest of Marketscape, in any table of facilities, you will be able to choose the claim type to be included in the table.
When choosing an option, if the claim type doesn't exist for the what you select, the table will be empty.