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documentation:cdm:procedure_cost [2016/05/03 19:44]
documentation:cdm:procedure_cost [2016/05/03 19:51] (current)
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 For prior definition, see below. For prior definition, see below.
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 +The PROCEDURE_COST table captures the cost of a Procedure performed on a Person. The information about the cost is only derived from the amounts paid for the Procedure. This is in contrast to the Drug Cost data which also contain information about true amount charged by the distributor. In addition, Revenue codes are captured.
 +|procedure_cost_id|Yes|integer|A unique identifier for each procedure cost record.|
 +|procedure_occurrence_id|Yes|integer|A foreign key identifier to the procedure record for which cost data are recorded.|
 +|currency_concept_id|No|integer|A concept representing the 3-letter code used to delineate international currencies, such as USD for US Dollar.|
 +|paid_copay|No|float|The amount paid by the Person as a fixed contribution to the expenses. Copay does not contribute to the out_of_pocket expenses.|
 +|paid_coinsurance|No|float|The amount paid by the Person as a joint assumption of risk. Typically, this is a percentage of the expenses defined by the health benefit Plan after the Person'​s deductible is exceeded.|
 +|paid_toward_deductible|No|float|The amount paid by the Person that is counted toward the deductible defined by the health benefit Plan.|
 +|paid_by_payer|No|float|The amount paid by the Payer. If there is more than one Payer, several PROCEDURE_COST records indicate that fact.|
 +|paid_by_coordination_benefits|No|float|The amount paid by a secondary Payer through the coordination of benefits.|
 +|total_out_of_pocket|No|float|The total amount paid by the Person as a share of the expenses|
 +|total_paid|No|float|The total amount paid for the expenses of the Procedure.|
 +|revenue_code_concept_id|No|integer|A foreign key referring to a Standard Concept ID in the Standardized Vocabularies for Revenue codes.|
 +|payer_plan_period_id|No|integer|A foreign key to the PAYER_PLAN_PERIOD table, where the details of the payer, plan and family are stored.|
 +|revenue_code_source_value|No|varchar(50)|The source code for the Revenue code as it appears in the source data, stored here for reference.|
 +==== Conventions ====
 +  * Each Procedure Occurrence may have any number of corresponding records in the PROCEDURE_COST table, but often it is none (cost data not captured) or one (one payment per Procedure). They are linked directly through the Procedure Occurrence ID field.
 +  * If Procedures payments are bundled and the cost of such a bundle might be represented in only one of the component Procedures. The FACT_RELATIONSHIP table contains the relationship between the charged Procedure and the Procedure belonging to the bundle.
 +  * The amounts paid are:
 +    * Copay – a fixed amount to be paid by the Person
 +    * Coinsurance – a relative amount of the total paid by the Person
 +    * Deductible – an amount of money paid by the Person before the Payer starts contributing
 +    * Primary Payer – the amount the primary Payer pays towards the total
 +    * Coordination of Benefits – the amount a secondary Payer or Family Plan pays towards the total
 +    * Out of Pocket = Copay + Coinsurance + Deductible
 +    * Total – the total amount paid for the Procedure
 +  * The amounts in various payment components should equal the total, so Copay + Coinsurance + Deductible + Primary Payer + COB = Total Paid. In reality, this is not always reflected in the source data. It is up to the ETL to determine how to deal with quality problems in the data.
 +  * The revenue_code_concept_id determines what service within a provider is charging for the service
documentation/cdm/procedure_cost.txt · Last modified: 2016/05/03 19:51 by cgreich