Medicare provider charge data

Updated August 2018

The Centers for Medicare & Medicaid Services has updated data showing what hospitals across the country charge Medicare for the same treatment or procedure. Government data files include bills submitted by 3,500 hospitals in federal fiscal years 2011 through 2016. This allows a basis for some local or regional comparisons and a starting point for stories on hospital costs and services.

AHCJ has gone one step further to help members compare hospitals from one year to the next by combining the files to include the hospital name, the diagnoses and procedures and the amount paid to the hospital. The file covers only inpatient charges. Beginning with FY2014 data, all discharges are reported. Prior years (FY2011 through FY2013) are limited to the top 100 most frequently billed discharges.

In addition to comparing costs, reporters can see if local hospitals have increased or decreased the treatment of specific conditions. Those changes might indicate changes in local physician population, changes in community needs, opening or closing of hospitals’ services, or even hospital marketing efforts.

For the AHCJ-prepared file, click here (44.8 MB). The documentation above and below will help you understand and use the data. And in downloading this file, you are bound by this important legal information.

Here are the definitions of each column in the AHCJ file:

DRG Definition – The code and description identifying the MS-DRG. MS-DRGs are a classification system that groups similar clinical conditions (diagnoses) and the procedures furnished by the hospital during the stay.
Provider Id – The provider identifier assigned to the Medicare-certified hospital facility.
Provider Name – The name of the provider.
Provider Street Address – The provider’s street address.
Provider City – The city where the provider is located.
Provider State – The state where the provider is located.
Provider Zip Code – The provider’s zip code.
Hospital Referral Region (HRR) Description – The Hospital Referral Region (HRR) where the provider is located.
Total Discharges 2016 – The number of discharges billed by the provider for inpatient hospital services.
Average Covered Charges 2016 – The provider’s average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments 2016 – The average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
Average Medicare Payments 2016 (not available for 2011) – The average amount that Medicare pays to the provider for Medicare’s share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits.
Total Discharges 2015 – The number of discharges billed by the provider for inpatient hospital services.
Average Covered Charges 2015 – The provider’s average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments 2015 – The average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
Average Medicare Payments 2015 (not available for 2011) – The average amount that Medicare pays to the provider for Medicare’s share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits.
Total Discharges 2014 – The number of discharges billed by the provider for inpatient hospital services.
Average Covered Charges 2014 – The provider’s average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments 2014 – The average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
Average Medicare Payments 2014 (not available for 2011) – The average amount that Medicare pays to the provider for Medicare’s share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits.
Total Discharges 2013 – The number of discharges billed by the provider for inpatient hospital services.
Average Covered Charges 2013 – The provider’s average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments 2013 – The average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
Average Medicare Payments 2013 – The average amount that Medicare pays to the provider for Medicare’s share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits.
Total Discharges 2012 – The number of discharges billed by the provider for inpatient hospital services.
Average Covered Charges 2012 – The provider’s average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments 2012 – The average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
Average Medicare Payments 2012 – The average amount that Medicare pays to the provider for Medicare’s share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits.
Total Discharges 2011 – The number of discharges billed by the provider for inpatient hospital services.
Average Covered Charges 2011 – The provider’s average charge for services covered by Medicare for all discharges in the DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments 2011 – The average of Medicare payments to the provider for the DRG including the DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in Total Payments are co-payment and deductible amounts that the patient is responsible for and payments by third parties for coordination of benefits.

Notes about this file

There are three common reasons for some of the numbers are blank:

Not every hospital lists every DRG Definition. If the hospital records 10 or fewer discharges per DRG Definition, then those are excluded for privacy concerns.
Beginning with FY2014 data, all discharges are reported. Prior years (FY2011 through FY2013) are limited to the top 100 most frequently billed discharges.
Hospitals might close, so new numbers could be missing for that reason as well.

More on medical costs

The cost of medicines, devices, tests and treatment is such an important element of health reporting that it is included in AHCJ’s Statement of Principles: “Strive to include information about cost and insurance coverage in any reporting of new ideas in medicine.”

Brenda Goodman, AHCJ’s former topic leader on covering medical studies says that the runaway costs of such things are arguably one of the most important issues in medicine, but it’s one that’s often missing from health stories.

Michael Schroeder, who covers health for Angie’s List Magazine, is required to include meaningful medical pricing information in his stories. He acknowledges this is no simple task but urges reporters to have a strategy and be persistent. “You won’t always get the information you’re after, but your batting average will certainly go up, and you won’t be left to routinely settle for hollow numbers.”

To that end, Goodman and Schroeder have contributed tip sheets to help reporters get that vital information. Goodman focuses on several resources where you might find pricing information, while Schroeder shares his strategy and the specific questions he asks sources about costs.