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Medicare - Inpatient
Dataset
Tags order and referring part b fiscal intermediary standard system part a
API Docs
Updated
May 16 2019
Views
9,894

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 discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2014. These MS-DRGs represent more than 7 million discharges or 75 percent of total Medicare IPPS discharges.
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Tags utilization payment hospital referral region inpatient diagnosis-related grouping and 4 more
API Docs
Updated
August 30 2017
Views
9,893

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
9,870

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 aca part b part a marketplace
API Docs
Updated
March 29 2017
Views
9,694

Medicare - Outpatient
Dataset
The CMS 2010 BSA Outpatient Procedures PUF originates from a 5% simple random sample of beneficiaries drawn (without replacement) from the 100% Beneficiary Summary File for reference year 2010.
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Tags claims
API Docs
Updated
March 29 2017
Views
9,332

Medicare - Durable Medical Equipment (DME)
Dataset
This release contains the Basic Stand Alone (BSA) Durable Medical Equipment (DME) Line Items Public Use Files (PUF) with information from Medicare DME claims. The CMS BSA DME Line Items PUF is a line item level file in which each record is a line item of a DME claim incurred by a 5% sample of Medicare beneficiaries (each claim is comprised of up to 13 line item services). Some demographic and line item related variables are provided in this PUF. However, as beneficiary identities are not provided, it is not possible to link claims that belong to the same beneficiary in the CMS BSA DME Line Items PUF. It is also not possible to link line item services that belong to the same claim.
The CMS BSA DME Line Items PUF originates from a 5% simple random sample of beneficiaries drawn (without replacement) from the 100% Beneficiary Summary File for the reference year. The sample that is used for the CMS BSA DME Line Items 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 BSA DME Line Items PUF and the 5% CMS research sample. It is also disjoint from the other BSA PUFs that have been released so far. This property prevents users from linking data across multiple files for identification purposes.
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Tags claims
API Docs
Updated
March 29 2017
Views
9,321

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 (130MB 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.
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 provider of services pos
API Docs
Updated
June 22 2017
Views
9,314

Medicare - Outpatient
Dataset
The Outpatient Hospital Utilization and Payment Public Use File (Outpatient Hospital PUF) presents information on comprehensive APC (C-APC) services provided to Medicare fee-for-service beneficiaries. The Outpatient Hospital PUF presents information on the number of APC services, hospitals' average total estimated submitted charges, the average Medicare allowed charges (which includes Medicare regular provider payments and beneficiary cost-sharing payments), the average Medicare regular provider payments, the number of APC services with outlier payments, and the average Medicare outlier provider payments among those services for 25 C-APC Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2015. The estimated average charges and the average Medicare payments are provided at the individual hospital level. The actual charges at an individual hospital for an individual service within these APC groups may differ.
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Tags 2015 mpup outpatient
API Docs
Updated
February 15 2019
Views
9,260

Medicare - Claims
Dataset
The CMS 2010 BSA Carrier Line Items PUF originates from a 5% simple random sample of beneficiaries drawn (without replacement) from the 100% Beneficiary Summary File for reference year 2010.
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Tags claims
API Docs
Updated
March 29 2017
Views
9,175

Medicare - Chronic Conditions
Dataset
The 2010 Chronic Conditions PUF is an aggregated file in which each record is a profile or cell defined by the characteristics of Medicare beneficiaries. A profile is defined by all combinations of age category, gender, various chronic conditions, and dual-eligibility status of the beneficiaries. Hence, the number of rows (or records) in the CMS 2008 Chronic Conditions PUF represents the number of unique profiles in the Medicare population. For each profile many claim-related variables are provided in the form of averages.
The CMS 2008 Chronic Conditions PUF represents 100% of the Medicare beneficiaries provided in the 100% Beneficiary Summary File for reference year 2008. The 100% Beneficiary Summary File is created annually and contains demographic, entitlement and enrollment data for beneficiaries who were: documented as being alive for some part of the reference year of the Beneficiary Summary File, are entitled to Medicare benefits during the reference year, and enrolled in Medicare Part A and/or Part B for at least one month in the reference year.
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Tags chronic conditions
API Docs
Updated
March 29 2017
Views
9,154

Medicare - Outpatient
Dataset
A provider level summary of Outpatient Prospective Payment System (OPPS) average estimated submitted charges and average Medicare Payments for 30 selected Ambulatory Payment Classification (APC) Groups.
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Tags apc hrr hospital referral region mpup
API Docs
Updated
August 30 2017
Views
9,151

Medicare - Part D
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 2016 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 opioidmap medicare part d 2016 zip code and 1 more
API Docs
Updated
May 1 2019
Views
9,139

Special Programs/Initiatives - Speed Adoption of Best Practices
Filtered View
[Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
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Tags No tags assigned
Updated
May 17 2019
Views
8,990

Medicare - Inpatient
Dataset
This is a Public Use File of Inpatient Claims drawn from the 2008 Beneficiary Summary File of Medicare beneficiaries enrolled during the calendar year 2008, and their associated Medicare claims. The most important aspects of this file are as follow: 1. It contains claims for a simple random sample of 5% of the 2008 beneficiary population. Out of approximately 2.4 million beneficiaries in the 5% sample, about 350,000 had claims (after excluding a relatively small fraction of ineligible claims), resulting in a Public Use File of just under 590,000 claims. 2. It contains six (6) analytic variables (in addition to an encrypted claim key): Age, gender, base DRG code, ICD-9 code, claim cost, and length of inpatient stay. All of these variables, except gender, have been suitably aggregated or averaged in order to protect individuals from identification, while retaining the analytic value of the data. 3. A claim for a sampled beneficiary is only included in the PUF if the combination of all six (6) variables is shared by at least eleven (11) claims pertaining to at least eleven (11) distinct beneficiaries in the population (but not necessarily the sample). 4. Claims cannot be linked by beneficiary, and cannot be linked to any external data source by means of the claim ID. The claim ID is a cryptographic key specific to this Inpatient Claims PUF and not available elsewhere. The inpatient Claims PUF is sorted by this claim ID to ensure that the relative position of claims in the PUF and the original source data are totally uncorrelated.
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Tags claims
API Docs
Updated
March 29 2017
Views
8,919

Medicare - Hospice
Dataset
This is a Public Use File from Hospice claims drawn from the 2008 Beneficiary Summary File of Medicare beneficiaries enrolled during the calendar year 2008, and their associated Medicare claims. The most important aspects of this file are as follow: 1. 5% simple random sample drawn without replacement from 100% 2008 Beneficiary Summary File. 2. This sample is disjoint from the existing 5% CMS Research Sample and the other 2008 PUFs. 3. Sample contained 2,392,893 unique beneficiaries of which 53,071 had at least one hospice claim.
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Tags claims
API Docs
Updated
March 29 2017
Views
8,640

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
8,584

Medicare - Enrollment
Dataset
Tags national supplier clearinghouse
API Docs
Updated
March 29 2017
Views
8,502

Medicare - Inpatient
Dataset
This data set presents hospital-level measure rates for the eight component indicators included in the AHRQ PSI-90 Composite measure for Medicare fee-for-service discharges from July 1, 2012 through June 30, 2014. Measure rates are presented for the following component indicators: PSI-3 – pressure ulcer, PSI-6 – iatrogenic pneumothorax, PSI-7 – central venous catheter-related bloodstream infection, PSI-8 – postoperative hip fracture, PSI-12 – perioperative pulmonary embolism or deep vein thrombosis, PSI-13 – postoperative sepsis, PSI-14 – postoperative wound dehiscence, and PSI-15 – accidental puncture or laceration. Public reporting of measure rates for PSI-6, PSI-12, PSI-14, PSI-15, and the PSI-90 Composite are also part of the Hospital Inpatient Quality Reporting Program and are posted on CMS’ Hospital Compare website.
*Footnote numbers reference Hospital Compare footnotes.
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Tags agency for healthcare research and quality
API Docs
Updated
May 8 2018
Views
8,391

Medicare - Enrollment
Dataset
Tags part b
API Docs
Updated
March 29 2017
Views
8,163

Special Programs/Initiatives
Dataset
The following dataset demonstrates the Medicare-enrolled MDPP suppliers from which eligible Medicare beneficiaries may be furnished MDPP services. If you receive your Medicare coverage via a Medicare Advantage plan, please consult your health plan to identify the specific MDPP suppliers that are available to you with no cost sharing
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Tags medicare diabetes prevention program diabetes
API Docs
Updated
May 2 2019
Views
8,119
Showing 81-100 of 757 results