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Knowledgebase
Introductory
Articles
CMS offers files from aggregate data to individual person level data. This article describes the differences between the aggregate, public use files, the limited data sets,…
This article describes the Federal Regulations that govern the release of CMS data for research.
The purpose of this article is to identify 1) common strengths of Medicare and Medicaid administrative data and 2) broad limitations for researchers to consider when…
Popular
Articles
To describe the CMS cell size suppression policy and provide examples of common scenarios and possible options.
This article provides guidance on how to identify hospital emergency room claims from the Medicare files.
Along with claims at the individual beneficiary (single enrollee/provider/visit) level, state Medicaid programs also submit service tracking claims which record lump sum…
Featured Article
There are many different provider variables in the Medicare Fee-for-Service (FFS) Claims and Encounter data. Researchers are often interested in the performing NPI and/or the facility CCN or organizational NPI, but other variables are sometimes…
CMS offers files from aggregate data to individual person level data. This article describes the differences between the aggregate, public use files, the limited data sets, and research identifiable files.
This article provides a link and overview of the document on finder and crosswalk files written by the CMS data distributor, Skyward Dynamics Information Technology (SDIT).
Provide the steps to identify the drug name from the RxNorm database for the NDCs in the BSA PDE PUF.
Doctoral students may request CMS data for their dissertation project. Students should consider several factors when deciding which type of data to use. This article presents considerations and resources for students interested to request CMS Research identifiable data.
This article describes the structure of the Medicare cost reports and provides instructions for identifying specific data elements for specific facilities. While the examples and screenshots provided below are specific to the hospital cost reports, the discussion on file structure and logic used for identifying specific variables are applicable to any facility cost report.
Researchers working with the Research Identifiable (RIF) MedPAR or Inpatient and Skilled Nursing Facility (SNF) claims may find records that do not appear to correspond to the year of the file. This article explains these instances.
The purpose of this article is to describe what ambulatory surgical centers are and to explain how this provider type differs from other provider types that bill Medicare.
Beginning in 2008, some hospital provider numbers appearing in the claims contain a “V” in the fifth position of the six-digit Medicare Provider Number. Usually, the fifth position is a number, not a character. These hospital provider numbers appear in the MedPAR, Inpatient and Outpatient files for both RIF and LDS versions. ResDAC recommends that researchers remove these claims. This is no longer a concern after 2015.
To describe the CMS cell size suppression policy and provide examples of common scenarios and possible options.
ResDAC faculty and Technical Advisors (TAs) are frequently asked to recommend a best algorithm for identifying cases, treatments, outcomes, etc.In the experience of ResDAC faculty, there is never a single best algorithm that meets all situations. There is often ambiguity with a mix of clear “yes”, clear “no” and a group in the middle (the “uncertain” ones). How exactly we define the three groups and what we do with that “uncertain” group depends on a variety of factors.
There are many different provider variables in the Medicare Fee-for-Service (FFS) Claims and Encounter data. Researchers are often interested in the performing NPI and/or the facility CCN or organizational NPI, but other variables are sometimes useful. The purpose of this article is to help you understand these variables and we present the completeness of these data to assist researchers who are designing research studies using Medicare FFS claims and Encounter data.
The purpose of this article is to provide an overview of the Centers for Medicare & Medicaid Services' (CMS') payment standardization process, as well as provide methodological documentation that explains how the standardized claim payment amounts for Medicare Part A, Part B, and Part D claims are calculated.