Tri-Service CHAMPUS Statistical Database Project (TCSDP): Department of the ArmyHealth Services Command CHAMPUS Catastrophic Payments Fourth Quarter, Fiscal Year 1992. Gateway Catchment Areas. Gateway to Care Management Analysis Series

摘要

This report presents in Appendix A, CHAMPUS Catastrophic Quarterly PaymentReports for the fourth Quarter, Fiscal Year (FY) 1992. For each of the original thirteen Gateway catchment areas, Privacy Act protected patient cases having CHAMPUS claims totaling more than the catchment area's specific catastrophic cutoff amount are listed with the changes in their net claim payments between reported and prior quarters. Each Payment Report includes the following for each patient: (1) patient unique Inpatient Record Number; (2) last hospital ending date on record; (3) last hospital and professional services voucher payment dates; (4) an indicator of whether the case involved a consolidation of hospital stays due to FI adjudication action; (5) DRG and diagnosis codes and their shortened names; (6) number of days spent in the hospital; (7) number of professional services; (8) patient age, sex and beneficiary category; (9) catastrophic amounts above the site's specified catastrophic cutoff amount as of the first and last days of the reported quarter; and (10) the difference of the two catastrophic totals which equals the catastrophic net payment made for each patient during the quarter. Table 1 at the end of the summary contains the CHAMPUS Catastrophic Quarterly Payment Schedule, listing the summary totals of each catchment area's number of catastrophic cases and catastrophic totals from the Payment Reports, summing over all catchment areas for the quarter.