Comparison of Medicaid Payments Relative to Medicare Using Inpatient Acute Care Claims from the Medicaid Program: Fiscal Year 2010-Fiscal Year 2011.

ABSTRACT:

Objective

To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments.

Data sources

Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer).

Study design

Medicaid FFS inpatient hospital claims were run through Medicare's MS-DRG grouper and IPPS pricer to compare Medicaid's actual payment against what Medicare would have paid for the same claim.

Principal findings

Average inpatient hospital claim payments for Medicaid were 68.8 percent of what Medicare would have paid in fiscal year 2010, and 69.8 percent in fiscal year 2011. Including Medicaid disproportionate share hospital (DSH), graduate medical education (GME), and supplemental payments reduces a subst

SUBMITTER: Stone DA 

PROVIDER: S-EPMC5785311 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature