Office of the Actuary at the Centers for Medicare & Medicaid Services, Baltimore, MD.
National Health Statistics Group, CMS Office of the Actuary, Baltimore, MD.
Health Serv Res. 2018 Feb;53(1):326-340. doi: 10.1111/1475-6773.12645. Epub 2017 Jan 10.
To compare Medicaid fee-for-service (FFS) inpatient hospital payments to expected Medicare payments.
Medicaid and Medicare claims data, Medicare's MS-DRG grouper and inpatient prospective payment system pricer (IPPS pricer).
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.
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 substantial proportion of the gap between Medicaid and Medicare payments.
Medicaid payments relative to expected Medicare payments tend to be lower and vary by state Medicaid program, length of stay, and whether payments made outside of the Medicaid claims process are included.
比较医疗补助按服务项目付费（FFS）住院医院支付与预期医疗保险支付。
医疗补助和医疗保险索赔数据、医疗保险的 MS-DRG 分组器和住院前瞻性支付系统定价器（IPPS 定价器）。
通过医疗保险的 MS-DRG 分组器和 IPPS 定价器运行医疗补助按服务项目付费住院医院索赔，以比较医疗保险对同一索赔的实际支付与医疗补助的实际支付。
在 2010 财年，医疗补助的平均住院医院索赔支付为医疗保险支付的 68.8%，在 2011 财年为 69.8%。包括医疗补助不成比例的分担医院（DSH）、研究生医学教育（GME）和补充支付，减少了医疗补助和医疗保险支付之间差距的很大一部分。
与预期医疗保险支付相比，医疗补助支付往往较低，并且因州医疗补助计划、住院时间以及是否包括医疗补助索赔程序之外的支付而有所不同。
