Cost Breakdown

EPISODE GROUPER SERVICE CATEGORY DESCRIPTIONS

Inpatient facilities include hospitals and nursing homes. This category includes all payments to inpatient facilities for any services; and supplies or medications provided by these facilities, billed to insurers on an inpatient facility bill, and paid by insurers.

Outpatient facilities include hospital outpatient departments or free-standing facilities such as imaging and ambulatory surgery centers. This category includes all payments to outpatient facilities for any services; and supplies, or medications provided by these facilities, billed to insurers on an outpatient facility bill, and paid by insurers.

Professional (and Other) services include all health care provider types except facilities and retail pharmacies: clinicians of all specialties, therapists, ambulance, home health care, durable medical equipment (DME) providers, etc. This category includes all payments to these providers for services; and supplies or medications provided by these professionals and others, billed to insurers on a professional bill, and paid by insurers.

Retail Pharmacy medication and supplies includes all payments for drugs and covered supplies provided by retail pharmacies, billed to insurers/pharmacy benefit managers on a prescription claim, and paid by insurers.

Potentially Avoidable Adverse Events also known as Potentially Avoidable Complication include oversights or errors in care that cause harm to the patient, and might have been prevented with more effective treatment. This category includes unexplainable variation in total costs of care that could be reasonably attributed to complications under the control of providers.