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…
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.
Requirements for Institutional Review Board (IRB) Review and HIPAA Waiver Documentation for RIF DUA Request Submissions
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…
Identifying Medicare Managed Care Beneficiaries from the Master Beneficiary Summary or Denominator Files
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.
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.
Beneficiary death information is available in several of the Medicare enrollment files. Limited death information is also found in other files, such as the MedPAR. This article describes the variables found in each.
This article describes three variable groups that can be used to identify managed care enrollment for Medicaid beneficiaries. Codes for the variables are also given that identify beneficiaries who received their comprehensive medical care under the Fee-For-Service (FFS) payment system.
The beneficiary eligibility and enrollment files have changed in content and name over the years. It is important to understand the timing of these changes and the unique features of each file if you are using older files or see them referenced in articles.
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 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.
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 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.
This article provides a link and overview of the document on finder and crosswalk files written by the CMS data distributor, HealthAPT.
CMS began offering quarterly claims and enrollment data with Quarter 3, 2015. This article describes the quarterly data file creation, availability, and pricing.