Home » Payment Source
Print this page

Release Notes:
Data Element
Version 2012B

Data Element Name: Payment Source
Collected For: All Records , Optional for HBIPS-2 and HBIPS-3
Definition:The source of payment for this episode of care.
Suggested Data Collection Question:What is the patient's source of payment for this episode of care?
Allowable Values:

1 Source of payment is Medicare.

2 Source of payment is NonMedicare.

Notes for Abstraction:
  • If Medicare is listed as the primary, secondary, tertiary, or even lower down on the list or payers, select "1".
  • If the patient has Medicaid only or Medicaid and another insurance type, other than Medicare, select "2". If the patient has Medicaid and Medicare, select "1".
  • If the patient is an Undocumented Alien or Illegal immigrant select "1". Undocumented Alien: Section 1011 of the Medicare Modernization Act of 2003 allows for reimbursement for services rendered to patients who are: Undocumented or illegal aliens (immigrants), Aliens who have been paroled into a United States port of entry and Mexican citizens permitted to enter the United States on a laser visa.
Suggested Data Sources:

  • Face sheet
  • UB-04, Field Location: 50A, B or C
Additional Notes:
Guidelines for Abstraction:
Inclusion Exclusion
Medicare includes, but is not limited to:
  • Medicare Fee for Service (includes DRG or PPS)
  • Black Lung
  • End Stage Renal Disease (ESRD)
  • Railroad Retirement Board (RRB)
  • Medicare Secondary Payer
  • Medicare HMO/Medicare Advantage
  • None

Payment Source
Specifications Manual for Joint Commission National Quality Measures (v2012B)
Discharges 07-01-12 (3Q12) through 12-31-12 (4Q12)