Updated research request forms and data security approval requirement effective 4/24/23
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
This article provides guidance on how to identify hospital emergency room claims from the Medicare files.
Providers that bill Medicare use codes for patient diagnoses and codes for care, equipment, and medications provided. This articles provides resources to identify the codes…
To describe the CMS cell size suppression policy and provide examples of common scenarios and possible options.
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…
The purpose of this article is to describe how to use the Medicare managed care enrollment information found in the Medicare Beneficiary Summary File (MBSF) Research Identifiable File (RIF) or Denominator in the Limited Data Set (LDS). Medicare managed care is sometimes also called Medicare Advantage, Medicare Part C or Medicare + Choice.
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 requesting and using the data.
This article presents the data options available to researchers studying the End-Stage Renal Disease (ESRD) population.
Medicare-paid observation stays may be found in the Medicare Outpatient, Inpatient, or MedPAR files. This article describes how to identify observation stays that appear in each as defined by CMS billing guidance.
For data years 2006 and forward, dually eligible Medicare beneficiaries are identified in the Medicare Master Beneficiary Summary File, Base segment. Initially available only as a RIF, this file was released as an LDS file in 2016. The monthly variable “Medicare-Medicaid Dual Eligibility” identifies dual status.
Dual eligibles are also identified in the Medicaid Analytic Extract (MAX) Personal Summary (PS) file.
The CMS National Plan and Provider Enumeration System (NPPES) provides basic information about all organization and individual providers with a National Provider Identifier (NPI). This article provides a brief overview of how to access the NPPES and the information that it contains.
Detailed information about Medicare Part D drug plan formularies is available in two CMS data files. Important differences in the files are outlined below, including whether or not the files can be linked to other data sources.
The Medicare Hospital Service Area File is one of the few CMS non-identifiable files that can be opened in Microsoft Excel. The article describes the steps to import the file into Excel.
A number of CMS Limited Data Set (LDS) files are released first as a Proposed Rule file and then as a Final Rule file. This article provides a brief description of the differences between those two files.
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.
CMS must ensure that all research requests for identifiable (RIF) data have IRB documentation to satisfy the requirements of the Common Rule and the Health Insurance Portability and Accountability Act (HIPAA). This article describes the requirements and presents examples of acceptable IRB documentation.
The IRB documentation must indicate that there was a review that satisfies the following two requirements:
This article summarizes two methods available to link mothers and their infants using the MAX data. Frequently researchers using the CMS Medicaid Analytic Extract (MAX) data are looking for ways to link mothers with their infants. Given the available identifiers in MAX data, there are two options.