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Cost table updates

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clairblacketer 2018-09-27 15:07:55 -04:00 committed by GitHub
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Documentation/CommonDataModel_Wiki_Files/StandardizedHealthEconomicsDataTables/COST.md
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The COST table captures records containing the cost of any medical entity recorded in one of the DRUG_EXPOSURE, PROCEDURE_OCCURRENCE, VISIT_OCCURRENCE, DEVICE_OCCURRENCE, OBSERVATION or MEASUREMENT tables.
The COST table captures records containing the cost of any medical event recorded in one of the OMOP clinical event tables such as DRUG_EXPOSURE, PROCEDURE_OCCURRENCE, VISIT_OCCURRENCE, VISIT_DETAIL, DEVICE_OCCURRENCE, OBSERVATION or MEASUREMENT.
The information about the cost is defined by the amount of money paid by the Person and Payer, or as the charged cost by the healthcare provider. So, the COST table can be used to represent both cost and revenue perspectives. The COST_TYPE_CONCEPT_ID field will use concepts in the Standardized Vocabularies to designate the source of the cost data. A reference to the health plan information in the PAYER_PLAN_PERIOD table is stored in the record that is responsible for the determination of the cost as well as some of the payments.
Each record in the cost table account for the amount of money transacted for the clinical event. So, the COST table may be used to represent both receivables (charges) and payments (paid), each transaction type represented by its COST_CONCEPT_ID. The COST_TYPE_CONCEPT_ID field will use concepts in the Standardized Vocabularies to designate the source (provenance) of the cost data. A reference to the health plan information in the PAYER_PLAN_PERIOD table is stored in the record for information used for the adjudication system to determine the persons benefit for the clinical event.
Field|Required|Type|Description
:-----------------------------|:--------|:------------|:----------------------------------------------------
@ -52,7 +52,7 @@ No.|Convention Description
| 3 | One cost record is generated for each money or currency amount associated with a record in one of the event tables. |
| 4 | The COST field represents the dollar amount, either incoming or outgoing |
| 5 | When dealing with summary costs, the cost of the goods or services the provider provides is often not known directly, but derived from the hospital charges multiplied by an average cost-to-charge ratio. This data is currently available for [NIS](https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp) datasets, or any other [HCUP](https://www.hcup-us.ahrq.gov/databases.jsp) datasets. See also cost calculation explanation from AHRQ | 6 | In claims data, total paid is considered the calculated field the payer expects the provider to get reimbursed for goods and services, based on the payer's contractual obligations. |
| 7 | Drug costs are composed of ingredient cost(the amount charged by the wholesale distributor or manufacturer), the dispensing fee(the amount charged by the pharmacy and the sales tax). The latter is usually very small and typically not provided by most source data, and therefore not included in the CDM. |
| 7 | Drug costs are composed of ingredient cost (the amount charged by the wholesale distributor or manufacturer), the dispensing fee (the amount charged by the pharmacy and the sales tax). |
| 8 | In claims data, generally there is one field representing the total payment from the payer for the service/device/drug. However, this field could be a calculated field if the source data provides separate payment information for the ingredient cost and the dispensing fee in case of prescription benefits. If there is more than one Payer in the source data, several cost records indicate that fact. The Payer reporting this reimbursement should be indicated under the PAYER_PLAN_ID field. |
| 10 | REVENUE_CODE_CONCEPT_ID: Revenue codes are a method to charge for a class of procedures and conditions in the U.S. hospital system.
| 11 | DRG_CONCEPT_ID: Diagnosis Related Groups are US codes used to classify hospital cases into one of approximately 500 groups. Only the MS-DRG system should be used (mapped to vocabulary_id 'DRG) and all other DRG values should be mapped to 0. |