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719 Results

Medicare - Durable Medical Equipment (DME)
Dataset
The 2013 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 2013 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.
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Tags provider durable medical equipment 2013 mpup dmepos
API Docs
Updated
October 31 2017
Views
13,196

Medicare
Filtered View
A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related Groups (DRG)
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Tags medicare cms health care providers ipps 100 diagnosis-related groups (drg) and 3 more
Updated
May 29 2014
Views
13,106

Special Programs/Initiatives - Long Term Care Facility Staffing Payroll-Based Journal
Dataset
Payroll-Based Journal staffing data submitted by long term care facilities. Data are presented as one row per work day, for each facility.
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Tags No tags assigned
API Docs
Updated
June 26 2018
Views
12,795

Medicare
Filtered View
A provider level summary of Inpatient Prospective Payment System (IPPS) discharges, average charges and average Medicare payments for the Top 100 Diagnosis-Related Groups (DRG)
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Tags state hospital referral region (hrr) health care providers cms inpatient and 3 more
Updated
May 29 2014
Views
12,506

Medicare - Enrollment
Dataset
The Deactivated NPI report contains NPPES data (NPI and Deactivation date) on all current deactivated NPIs in NPPES since May 23, 2005. Each monthly report will contain the cumulative list of NPIs that have a current status of ‘Deactivated’ in NPPES. (Reactivated NPIs will be removed from the NPPES Monthly Deactivated NPI Reports.)
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Tags national plan and provider enumeration system
API Docs
Updated
March 29 2017
Views
12,387

Medicare - Inpatient
Dataset
The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2013. These DRGs represent more than 7 million discharges or 60 percent of total Medicare IPPS discharges.
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Tags hospital referral region hrr diagnosis-related grouping mpup payment and 3 more
API Docs
Updated
August 30 2017
Views
12,135

Medicare - Enrollment
Dataset
The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV).
The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
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Tags providers pos
API Docs
Updated
June 22 2017
Views
12,098

Medicare - Inpatient
Dataset
Hospital Level calculations for 8 Hospital Acquired Conditions (data period: July 1, 2010 through June 30, 2012)
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Tags hac
API Docs
Updated
December 11 2017
Views
12,036

Medicare - Part D
Dataset
The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), with information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.
Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, 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 or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided. For additional limitations, please review the methodology document in the About tab.
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Tags drug brand name prescriber part d 2013 and 5 more
API Docs
Updated
October 31 2017
Views
11,626

Medicare - Inpatient
Dataset
The Inpatient Utilization and Payment Public Use File (Inpatient PUF) provides information on inpatient discharges for Medicare fee-for-service beneficiaries. The Inpatient PUF includes information on utilization, payment (total payment and Medicare payment), and hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments. The PUF is organized by hospital and Medicare Severity Diagnosis Related Group (MS-DRG) and covers Fiscal Year (FY) 2015. MS-DRGs included in the PUF represent more than 7 million discharges or 75 percent of total Medicare IPPS discharges.
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Tags hrr hospital referral region payment diagnosis-related grouping utilization and 4 more
API Docs
Updated
October 31 2017
Views
11,489

Special Programs/Initiatives - Comprehensive Primary Care (CPC)
Dataset
The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.
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Tags aca special program medicaid demonstration marketplace and 3 more
API Docs
Updated
September 25 2017
Views
11,052

Medicare - Claims
Dataset
The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Part D Opioid Prescriber Summary File, which presents information on the individual opioid prescribing rates of health providers that participate in Medicare Part D program. This file is a prescriber-level data set that provides data on the number and percentage of prescription claims (includes new prescriptions and refills) for opioid drugs, and contains information on each provider’s name, specialty, state, and ZIP code. This summary file was derived from the 2014 Part D Prescriber Summary Table (Documentation available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Prescriber_Methods.pdf)
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Tags opioid zip code opioidmap prescriber medicare part d
API Docs
Updated
May 17 2017
Views
10,851

Medicare - Home Health Agency (HHA)
Dataset
The CMS 2008 BSA HHA Beneficiary PUF originates from a 5% simple random sample of beneficiaries drawn (without replacement) from the 100% Beneficiary Summary File for reference year 2008. The sample that is used for the CMS 2008 BSA HHA Beneficiary PUF is disjoint from the existing 5% CMS research sample in the sense that there is no overlap in terms of the beneficiaries in the CMS 2008 BSA HHA Beneficiary PUF and the 5% CMS research sample.
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Tags claims
API Docs
Updated
March 29 2017
Views
10,124

Medicare - Clinical Laboratory Improvement Amendments (CLIA/lab)
Dataset
The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV).
The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016.
Data Issue 1: Incorrect Certificate Data
Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used.
Fields
SHORT DESCRIPTION LEN START END TYPE
Application Type Code 1 475 475 VARCHAR2
Description: Type of CLIA certificate applied for by a laboratory.
SAS Name: APLCTN_TYPE_CD
COBOL Name: APLCTN-TYPE-CD
CLIA Certificate Effective Date 8 478 485 DATE
Description: Start date of the certificate.
SAS Name: CRTFCT_EFCTV_DT
COBOL Name: CRTFCT-EFCTV-DT
CLIA Certificate Mailed Date 8 486 493 DATE
Description: Date the certificate was generated for mailing.
SAS Name: CRTFCT_MAIL_DT
COBOL Name: CRTFCT-MAIL-DT
CLIA Certificate Type Code 1 494 494 VARCHAR2
Description: Type of certificate issued to the laboratory, based on
the application type code.
SAS Name: CRTFCT_TYPE_CD
COBOL Name: CRTFCT-TYPE-CD
CLIA Termination Code 2 529 530 VARCHAR2
Description: Identifies a laboratory's active or terminated status.
If terminated, identifies the reason.
SAS Name: CLIA_TRMNTN_CD
COBOL Name: CLIA-TRMNTN-CD
Data Issue 2: Labs Never Certified Included in POS
CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
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Tags clinical laboratory improvement amendments
API Docs
Updated
March 29 2017
Views
10,064

Special Programs/Initiatives - Speed Adoption of Best Practices
Filtered View
Tags No tags assigned
Updated
September 24 2018
Views
10,046

Medicare - Outpatient
Dataset
The data provided here include estimated hospital-specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2012. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
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Tags hrr apc supplier mpup hospital referral region
API Docs
Updated
August 30 2017
Views
9,885

Medicare - Enrollment
Dataset
The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV).
The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
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Tags providers
API Docs
Updated
March 29 2017
Views
9,833

Medicare - Clinical Laboratory Improvement Amendments (CLIA/lab)
Dataset
The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV).
The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016.
Data Issue 1: Incorrect Certificate Data
Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used.
Fields
SHORT DESCRIPTION LEN START END TYPE
Application Type Code 1 475 475 VARCHAR2
Description: Type of CLIA certificate applied for by a laboratory.
SAS Name: APLCTN_TYPE_CD
COBOL Name: APLCTN-TYPE-CD
CLIA Certificate Effective Date 8 478 485 DATE
Description: Start date of the certificate.
SAS Name: CRTFCT_EFCTV_DT
COBOL Name: CRTFCT-EFCTV-DT
CLIA Certificate Mailed Date 8 486 493 DATE
Description: Date the certificate was generated for mailing.
SAS Name: CRTFCT_MAIL_DT
COBOL Name: CRTFCT-MAIL-DT
CLIA Certificate Type Code 1 494 494 VARCHAR2
Description: Type of certificate issued to the laboratory, based on
the application type code.
SAS Name: CRTFCT_TYPE_CD
COBOL Name: CRTFCT-TYPE-CD
CLIA Termination Code 2 529 530 VARCHAR2
Description: Identifies a laboratory's active or terminated status.
If terminated, identifies the reason.
SAS Name: CLIA_TRMNTN_CD
COBOL Name: CLIA-TRMNTN-CD
Data Issue 2: Labs Never Certified Included in POS
CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
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Tags clinical laboratory improvement amendments
API Docs
Updated
March 29 2017
Views
9,784

Medicare - Enrollment
Dataset
Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted. Between now and March 23, 2015, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so. Please note that 42 CFR 424.515(d) provides CMS the authority to conduct these off-cycle revalidations.
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Tags part a part b aca marketplace
API Docs
Updated
March 29 2017
Views
9,472

Medicare - Inpatient
Dataset
Tags fiscal intermediary standard system part a part b order and referring
API Docs
Updated
September 20 2018
Views
9,342
Showing 61-80 of 719 results