Comparing Hospice Annual vs. Quarterly Claims Files

02/03/22 at 04:05 PM by Cordt Kassner

Comparing Hospice Annual vs. Quarterly Claims Files
Cordt T. Kassner, PhD, CEO Hospice Analytics, 12/14/18 - Updated 2/3/22

What you need to know: There is no longer a significant difference between Medicare Hospice Annual vs. Quarterly Claims.

Hospice Analytics Data Plan:
We are changing to Quarterly Claim updates for Premire Reports now. We are changing to Quarterly Claim updates for Physician Reports later this year. This decision is based on research detailed below.

In December 2018, I compared Medicare's 2016 Hospice Annual Claims Files to the 2016 Hospice Quarterly Claims file. This meant purchasing both sets of claims for the sole purpose of comparing them. I compared both sets of claims to each other, to the MedPAC Report discussing 2016 claims, and to Medicare Reports. I researched Medicare claims maturation dates to understand why significantly more claims are processed within 12 months compared to 3 months. And indeed, there was a significant difference between the claims files - Annual Claims were much more complete and reliable than Quarterly Claims. This is why Hospice Analytics has been relying on Annual files for complete reliable information, and supplementing Q1 and Q2 files to be current. Then, when the Annual files were released, we discarded the Quarterly files and updated all our reports with Annual Claims information.

Current Methods:
In January 2022, I compared Medicare's 2020 Hospice Annual Claims files to the 2020 Hospice Quarterly Claims files. This meant again purchasing both sets of claims for the sole purpose of comparing them.

I compared 2020 Hospice Annual Claims files to 2020 Hospice Quarterly Claims files and found insignificant differences between the Annual vs. Quarterly files. I compared several fields, including:

  1. Number of unduplicated beneficiaries admitted to hospice
  2. Hospice deaths (to determine hospice utilization rates)
  3. Total days of care
  4. Mean and median lengths of stay
  5. Total payments
  6. Mean payments per beneficiary

In comparing Annual vs Quarterly claims, these metrics were all within 2% of each other (most were within 1%).

Hospice Annual vs. Quarterly Claims files used to be significantly different, but now they have insignificant differences. Why? I believe over the past few years, Medicare has refined their processes to provide more robust Quarterly Claims. It is possible that as with all things 2020, Medicare simply paid more claims (i.e., reviewed / slowed processing of fewer claims) to better serve providers during the Public Health Emergency (i.e., COVID-19). However, over the years, I continue to see CMS providing more information and better service to improve access to high quality care. (Now if only they could reduce prices for claims files! :)

Hospice Analytics continues to provide you with the most complete, accurrate, reliable information available in easy-to-use formats at an affordable price to better serve all those near the end of life. We research questions and opportunities, and try to clearly communicate our findings. Please contact me with any questions or concerns. Thank you!


Back to Healthcare Policy