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Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2020 report period (claims submitted July 1, 2018 through June 30, 2019). These claims were used to calculate the FY 2020 Medicare FFS improper payment rate.

The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags medicare improper payment fee-for-service comprehensive error rate testing cert
API Docs
Created
January 21 2021
Views
642

Medicare - Durable Medical Equipment (DME)
Dataset
The 2018 Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (herein referred to as “Referring Provider DMEPOS PUF”) presents information on DMEPOS products and services provided to Medicare beneficiaries ordered by physicians and other healthcare professionals. The Referring Provider DMEPOS PUF contains data on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code and supplier rental indicator. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Referring Provider DMEPOS PUF covers calendar year 2018 and contains final-action (i.e., all claim adjustments have been resolved) Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.
While the Referring Provider DMEPOS PUF has a wealth of information on payment and utilization for Medicare DMEPOS services, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. For additional limitations, please review the methodology document available below.
Tags mpup utilization suppliers referrals medicare and 8 more
API Docs
Created
October 30 2020
Views
937

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2019 report period (claims submitted July 1, 2017 through June 30, 2018). These claims were used to calculate the FY 2019 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags fee-for-service medicare cert improper payment comprehensive error rate testing
API Docs
Created
December 30 2019
Views
2,291

Medicare - Durable Medical Equipment (DME)
Dataset
The 2017 Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (herein referred to as “Referring Provider DMEPOS PUF”) presents information on DMEPOS products and services provided to Medicare beneficiaries ordered by physicians and other healthcare professionals. The Referring Provider DMEPOS PUF contains data on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code and supplier rental indicator. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Referring Provider DMEPOS PUF covers calendar year 2016 and contains final-action (i.e., all claim adjustments have been resolved) Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.
While the Referring Provider DMEPOS PUF has a wealth of information on payment and utilization for Medicare DMEPOS services, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. For additional limitations, please review the methodology document available below.
Tags durable medical equipment prosthetics payments supplies medicare and 8 more
API Docs
Created
May 22 2019
Views
5,120

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2018 report period (claims submitted July 1, 2016 through June 30, 2017). These claims were used to calculate the FY 2018 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags medicare comprehensive error rate testing cert improper payment fee-for-service
API Docs
Created
January 2 2019
Views
642

Special Programs/Initiatives - Medicare Shared Savings Program (MSSP)
Dataset
Aggregate data consisting of per capita Parts A and B FFS expenditures, average CMS-HCC prospective risk scores and total person-years for assignable beneficiaries by Medicare enrollment type (End Stage Renal Disease (ESRD), disabled, aged/dual eligible, aged/non-dual eligible). It is the intent of CM to publish this PUF annually, in the summer following the conclusion of the calendar year to which it relates.
Tags medicare shared savings program aco county ssp and 2 more
API Docs
Created
September 7 2018
Views
2,989

Medicare - Durable Medical Equipment (DME)
Dataset
The 2016 Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (herein referred to as “Referring Provider DMEPOS PUF”) presents information on DMEPOS products and services provided to Medicare beneficiaries ordered by physicians and other healthcare professionals. The Referring Provider DMEPOS PUF contains data on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code and supplier rental indicator. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Referring Provider DMEPOS PUF covers calendar year 2016 and contains final-action (i.e., all claim adjustments have been resolved) Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.
While the Referring Provider DMEPOS PUF has a wealth of information on payment and utilization for Medicare DMEPOS services, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. For additional limitations, please review the methodology document available below.
Tags orthotics 2016 referrals suppliers medicare and 8 more
API Docs
Created
May 8 2018
Views
5,707

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2017 report period (claims submitted July 1, 2015 through June 30, 2016). These claims were used to calculate the FY 2017 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags medicare cert fee-for-service comprehensive error rate testing improper payment
API Docs
Created
March 12 2018
Views
2,180

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2016 report period (claims submitted July 1, 2014 through June 30, 2015). These claims were used to calculate the FY 2016 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags fee-for-service medicare cert improper payment comprehensive error rate testing
API Docs
Created
March 12 2018
Views
483

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2015 report period (claims submitted July 1, 2013 through June 30, 2014). These claims were used to calculate the FY 2015 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags fee-for-service cert comprehensive error rate testing medicare improper payment
API Docs
Created
March 12 2018
Views
396

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2014 report period (claims submitted July 1, 2012 through June 30, 2013). These claims were used to calculate the FY 2014 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags fee-for-service improper payment comprehensive error rate testing medicare cert
API Docs
Created
March 12 2018
Views
350

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2013 report period (claims submitted July 1, 2011 through June 30, 2012). These claims were used to calculate the FY 2013 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags comprehensive error rate testing cert medicare fee-for-service improper payment
API Docs
Created
March 12 2018
Views
266

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2012 report period (claims submitted July 1, 2010 through June 30, 2011). These claims were used to calculate the FY 2012 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags cert improper payment fee-for-service comprehensive error rate testing medicare
API Docs
Created
March 12 2018
Views
277

Medicare - Claims
Dataset
The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2011 report period (claims submitted January 1, 2010 through December 31, 2010). These claims were used to calculate the FY 2011 Medicare FFS improper payment rate.
The Comprehensive Error Rate Testing (CERT) program’s public data contains the claims reviewed from the Medicare Fee-for-Service (FFS) universe for each reporting period. To minimize the risk of beneficiary identification of each claim, Healthcare Common Procedure Coding System (HCPCS) codes that are considered rare (defined as having 10 or fewer claims in the Medicare FFS universe for the reporting period) are removed from the public data for each reporting period. Additionally, a service that is provided by a singular provider or supplier can be removed from the public data dependent upon stakeholder feedback.
Tags medicare comprehensive error rate testing fee-for-service improper payment cert
API Docs
Created
March 12 2018
Views
340

Special Programs/Initiatives - Medicare Shared Savings Program (MSSP)
Dataset
Aggregate data consisting of per capita Parts A and B FFS expenditures, average CMS-HCC prospective risk scores and total person-years for assignable beneficiaries by Medicare enrollment type (End Stage Renal Disease (ESRD), disabled, aged/dual eligible, aged/non-dual eligible). It is the intent of CM to publish this PUF annually, in the summer following the conclusion of the calendar year to which it relates.
Tags aco ssp county fee for service medicare and 2 more
API Docs
Created
October 26 2017
Views
2,547

Medicare - Durable Medical Equipment (DME)
Dataset
The 2015 Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (herein referred to as “Referring Provider DMEPOS PUF”) presents information on DMEPOS products and services provided to Medicare beneficiaries ordered by physicians and other healthcare professionals. The Referring Provider DMEPOS PUF contains data on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code and supplier rental indicator. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Referring Provider DMEPOS PUF covers calendar year 2015 and contains final-action (i.e., all claim adjustments have been resolved) Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.
While the Referring Provider DMEPOS PUF has a wealth of information on payment and utilization for Medicare DMEPOS services, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. For additional limitations, please review the methodology document available below.
Tags durable medical equipment medicare mpup referrals suppliers and 8 more
API Docs
Created
March 15 2017
Views
3,928

Special Programs/Initiatives - Medicare Shared Savings Program (MSSP)
Dataset
Aggregate data consisting of per capita Parts A and B FFS expenditures, average CMS-HCC prospective risk scores and total person-years for assignable beneficiaries by Medicare enrollment type (End Stage Renal Disease (ESRD), disabled, aged/dual eligible, aged/non-dual eligible). It is the intent of CM to publish this PUF annually, in the summer following the conclusion of the calendar year to which it relates.
Tags fee for service risk score shared savings program ssp medicare and 3 more
API Docs
Created
January 20 2017
Views
1,416

Special Programs/Initiatives - Medicare Shared Savings Program (MSSP)
Dataset
Aggregate data consisting of per capita Parts A and B FFS expenditures, average CMS-HCC prospective risk scores and total person-years for assignable beneficiaries by Medicare enrollment type (End Stage Renal Disease (ESRD), disabled, aged/dual eligible, aged/non-dual eligible). It is the intent of CM to publish this PUF annually, in the summer following the conclusion of the calendar year to which it relates.
Tags aco medicare county ssp shared savings program and 2 more
API Docs
Created
January 19 2017
Views
1,888

Medicare - Claims
Dataset
The hospital readmission rate PUF presents nation-wide information about inpatient hospital stays that occurred within 30 days of a previous inpatient hospital stay (readmissions) for Medicare fee-for-service beneficiaries. The readmission rate equals the number of inpatient hospital stays classified as readmissions divided by the number of index stays for a given month. Index stays include all inpatient hospital stays except those where the primary diagnosis was cancer treatment or rehabilitation. Readmissions include stays where a beneficiary was admitted as an inpatient within 30 days of the discharge date following a previous index stay, except cases where a stay is considered always planned or potentially planned. Planned readmissions include admissions for organ transplant surgery, maintenance chemotherapy/immunotherapy, and rehabilitation.
This dataset has several limitations. Readmissions rates are unadjusted for age, health status or other factors. In addition, this dataset reports data for some months where claims are not yet final. Data published for the most recent six months is preliminary and subject to change. Final data will be published as they become available, although the difference between preliminary and final readmission rates for a given month is likely to be less than 0.1 percentage point.
Data Source: The primary data source for these data is the CMS Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For complete information regarding data in the CCW, visit http://ccwdata.org/index.php.
Study Population: Medicare fee-for-service beneficiaries with inpatient hospital stays.
Tags 30 day fee for service ffs medicare readmissions
API Docs
Created
January 17 2017
Views
5,677

Medicare - Durable Medical Equipment (DME)
Dataset
The 2014 Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (herein referred to as “Referring Provider DMEPOS PUF”) presents information on DMEPOS products and services provided to Medicare beneficiaries ordered by physicians and other healthcare professionals. The Referring Provider DMEPOS PUF contains data on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code and supplier rental indicator. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Referring Provider DMEPOS PUF covers calendar year 2014 and contains final-action (i.e., all claim adjustments have been resolved) Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.
While the Referring Provider DMEPOS PUF has a wealth of information on payment and utilization for Medicare DMEPOS services, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. For additional limitations, please review the methodology document available below.
Tags provider 2013 dmepos utilization medicare and 8 more
API Docs
Created
October 27 2016
Views
2,417