RIF Data Analysis

RIF export ratios need adjustment:

• ratio of types of claims overall
• ratio of claim types per bene
• ratio of lines per claim type

Claim Ratio = Claim of Type / Claim Total across all types
Synthea Total:  1,054,589,695
Actual Total:  23,195,755,891

Table	Claim % (Synthea)	Claim % (Actual)	Notes
carrier	12.94	31.05	underrepresented in Synthea
dme	0.12	2.19	slightly underrepresented in Synthea
hha	2.13	0.43	slightly overrepresented in Synthea
hospice	0.21	0.17
inpatient	2.66	0.39	slightly overrepresented in Synthea
outpatient	25.26	6.13	largely overrepresented in Synthea
partd	56.38	59.48
snf	0.29	0.16

Table	Average Line/Claim (Synthea)	Average Line/Claim (Actual)	Notes
carrier	9.46	2.03	overrepresented in Synthea
dme	1.00	1.78
hha	1.07	11.13	underrepresented in Synthea
hospice	51.95	21.12	largely overrepresented in Synthea
inpatient	1.98	17.21	largely underrepresented lines in Synthea
outpatient	1.18	7.15	underrepresented lines in Synthea
snf	103.6	8.02	vastly overrepresented proportions in Synthea

Source	Claims per Beneficiary (avg)
Actual	278.87
Synthea	104.62

Synthea generation is underproducing claims/bene by 266%

This is across all years though, so it may be misleading.

"Actual" counts as of analysis time.

Table	Count
beneficiaries	83,178,011
carrier_claims	7,203,110,966
carrier_claim_lines	14,634,334,226
dme_claims	508,634,611
dme_claim_lines	906,349,376
hha_claims	99,501,281
hha_claim_lines	1,107,370,953
hospice_claims	38,666,143
hospice_claim_lines	816,469,361
inpatient_claims	89,647,553
inpatient_claim_lines	1,543,093,724
outpatient_claims	1,422,291,392
outpatient_claim_lines	10,165,216,482
partd_events	13,797,179,329
snf_claims	36,724,616
snf_claim_lines	294,853,836