The Medicare Outpatient (Encounter) file contains Medicare Advantage plan paid records from a variety of outpatient providers. Examples of institutional outpatient providers include hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, comprehensive outpatient rehabilitation facilities, Federally Qualified Health Centers and community mental health centers.
This file includes (variable highlights):
- diagnosis (ICD diagnosis) codes
- HCPCS code
- Revenue center codes, dates, unit counts
- Part C Benefit Package and Contract number
- Organization NPI number
- No payment information
- Encounter records submitted to CMS by September, 2021 for dates of service in CY 2019
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness programs). Encounter data will include records for these additional items and services provided under the plan.