| Output Column |
Description |
Methodology |
| RawRowID |
A unique identifier for each row. This value in combination with the hospital_id should uniquely identify a record. |
|
| CreatedOn |
The date and time that the MRF was extracted. |
|
| HospitalID |
A UUID for a particular hospital that is unique for a particular year that the MRF is posted for. The same physical hospital will have 2 different hospital_id values for 2 different calendar years. |
|
| HospitalTemplateID |
A persistent UUID for a particular hospital. Each year when a hospital posts a new MRF, this ID remains constant and allows for connecting the data extracted from MRFs over time. |
|
| HospitalName |
The legal business name of the licensee. This value is the hospital_name obtained from within the MRF file. |
|
| HospitalAddress |
The geographic address of the corresponding hospital location. |
|
| LastUpdatedOn |
Date on which the MRF was last updated. |
|
| HospitalRegion |
The state which the hospital location appears under on the CMS-HPT.txt file. |
|
| HealthSystemID |
A UUID that allows tying together different hospitals belonging to the same health system. |
|
| HealthSystem |
The name of the health system that the hospital belongs to. |
|
| Code |
A standardized version of the "code" column available in the raw MRF. This value is cleaned using the code_type column. |
|
| CodeType |
The corresponding coding type for the code data element. Example values: CPT, HCPCS, MS-DRG, APR-DRG, APC, RC, etc. |
|
| Setting |
Indicates whether the item or service is provided in connection with an inpatient admission or an outpatient department visit. Valid values: "inpatient", "outpatient", "both". |
|
| Modifiers |
Include any modifier(s) that may change the standard charge that corresponds to hospital items or services. |
|
| DrugUnitOfMeasurement |
If the item or service is a drug, indicate the unit value that corresponds to the established standard charge. |
|
| DrugTypeOfMeasurement |
The measurement type that corresponds to the established standard charge for drugs as defined by either the National Drug Code or the National Council for Prescription Drug Programs. |
|
| PayerName |
A standardized version of the payer name. For example "UHC" will get standardized to "UnitedHealthcare". |
If no standardized version is present, this will match the RawPayerName field. |
| RawPayerName |
The name of the third-party payer that is, by statute, contract, or agreement, legally responsible for payment of a claim for a healthcare item or service. |
Note: "Cash Pay" will appear in this column. This is the charge that applies to an individual who pays cash (or cash equivalent) for a hospital item or service. |
| PayerProduct |
Valid values: HMO, EPO, PPO, POS, Medicare, Medicaid |
Inferred from the payer_name or plan_name that appears on the MRF record. |
| PayerClass |
Valid values: Commericial, Exchange, Military, Medicare, Medicaid |
Inferred from the payer_name or plan_name that appears on the MRF record. |
| PlanName |
The name of the payer's specific plan associated with the standard charge. |
|
| Description |
Description of each item or service provided by the hospital that corresponds to the standard charge the hospital has established. |
|
| StandardGrossCharge |
Gross charge is the charge for an individual item or service that is reflected on a hospital's chargemaster, absent any discounts. |
|
| NegotiatedRateDollar |
Payer-specific negotiated charge (expressed as a dollar amount) that a hospital has negotiated with a third-party payer for the corresponding item or service. |
|
| NegotiatedRatePercentage |
Payer-specific negotiated charge (expressed as a percentage) that a hospital has negotiated with a third-party payer for an item or service. |
|
| StandardChargeNegotiatedAlgorithm |
Payer-specific negotiated charge (expressed as an algorithm) that a hospital has negotiated with a third-party payer for the corresponding item or service. |
|
| EstimatedAmount |
Estimated allowed amount means the average dollar amount that the hospital has historically received from a third party payer for an item or service. If the standard charge is based on a percentage or algorithm, the MRF must also specify the estimated allowed amount for that item or service. |
|
| StandardChargeMethodology |
Method used to establish the payer-specific negotiated charge. The valid value corresponds to the contract arrangement. |
|
| AdditionalPayerNotes |
A free text data element used to help explain data in the file that is related to a payer-specific negotiated charge. |
|
| AdditionalGenericNotes |
A free text data element that is used to help explain any of the data including, for example, blanks due to no applicable data, charity care policies, or other contextual information that aids in the public's understanding of the standard charges. |
|
| Baseline |
The baseline rate for the given code, modifier, place of service, and billing class combination. |
We update our baseline rate tables annually or quarterly by pulling the tables directly from CMS. |
| BaselineSchedule |
A string indicating the baseline schedule used to generate the baseline_rate value. |
By default, Serif Health uses the fields in each row to select the most appropriate CMS baseline schedule. IPPS, OPPS, Lab, Drug ASP, Anesthesia, and ASC schedules are supported and display their national payment amount for the billing code. For PFS, a MAC is selected baed on the hospital location, and the MAC value is used to set the baseline. If a MAC cannot be mapped, the PFS national payment amount value is used. |
| RelativeToBaseline |
The ratio of the rate divided by the baseline. When the baseline is a CMS-dictated dollar payment amount, this column represents "percent of CMS" for the relevant BaselineSchedule. When the baseline is a weight, this column represents a "base rate" commonly used for negotiating inpatient or anesthesia pricing. |
Decimal division of the rate by the baseline. If the baseline column is not populated for the given record, this column will be blank. |
