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 define a Long-Term Care Hospital (LTCH) and to identify the files that contain claims submitted by a LTCH.
CMS offers several claim-level files that contain outpatient claims; that is, facility claims submitted for care covered under Part B. Three versions of the LDS files are described:Outpatient file,Outpatient Prospective Payment System (OPPS) file, and OPPS Partial Hospitalization file.
Claims for ambulance services are found in both the Carrier and the Outpatient claims data. This article describes how to identify ambulance services.
With the exception of PY 2014, CMS research files do not include beneficiary risk adjustment scores. However, CMS does provide the programming code and instructions to calculate the three risk adjustments that CMS uses as the basis for managed care payment.
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 article provides resources for obtaining statistics and reports related to the Medicare and Medicaid programs and their beneficiaries. The following Medicare/Medicaid statistical and summary data resources address some of the most common requests for this type of information. These are by no means exhaustive.
Occasionally researchers need to obtain identifiable data for MCBS participants, including claims data outside MCBS participation (i.e. before or after the individual participates in the MCBS). This article provides a brief overview of that process.
This article outlines the availability of date of service information for the Limited Data Set (LDS) Medicare claims files.
Researchers may now request Research Identifiable File (RIF) Medicare data on a quarterly basis, in addition to the annual files. Data available on a quarterly basis includes Medicare Research Identifiable FFS claims (Inpatient, Outpatient, Home Health Agency, Hospice, Skilled Nursing Facility, Carrier, and Durable Medical Equipment) and the Master Beneficiary Summary File: Base A/B segment.
CMS began offering quarterly claims and enrollment data with Quarter 3, 2015. This article describes the quarterly data file creation, availability, and pricing.
Researchers who are interested in studying inpatient utilization (e.g. hospital stays) have two options: the Inpatient claims file or the Medicare Provider Analysis and Review (MedPAR) file. It is important to note that the differences between the two files will vary depending on whether a researcher is interested in the Research Identifiable File (RIF) or Limited Data Set (LDS) versions of the two files.
Hospitals may submit multiple claims for some hospitalizations. This article provides guidance for counting distinct inpatient hospitalizations and for sequencing claims for each distinct hospitalization found in the Inpatient Research Identifiable File (RIF) and Limited Data Set (LDS) files. This guidance is not applicable to the MedPAR because each record in that file is already a distinct hospitalization.