Medicare

Medicare is a health insurance program, administered by the United States government, for people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other special criteria like the End Stage Renal Disease program (ESRD).

Medicare Advantage Beneficiary and Plan Information

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicare Encounter Data for Research.

This presentation overviews key variables describing Medicare Advantage enrollment in the MBSF: 

  • Monthly enrollment and plan contract identifier variables to identify enrollment.
  • Variables used to link the MBSF and to the plan characteristics file; and 
  • Variables characterizing plans (e.g. plan type, special needs plans indicators, supplemental benefits, etc.) from the plan characteristics file.

Encounter Data Source and Processing

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicare Encounter Data for Research.

This presentation describes where to find information on encounter data submission, which plans are required to submit and required submission data elements. Key differences between encounters and claims for payment are described. Chart review records, a unique feature of encounter data, are also introduced.

Overview of the History and Structure of Medicare Advantage and Comparison of FFS and MA Enrollees

Date Recorded

This video is one segment in a series of videos from ResDAC’s Introduction to the Use of the Medicare Encounter Data for Research.

This presentation overviews the history of the Medicare and Medicare Advantage program, policy developments which influence the data over time, and a description of the beneficiaries enrolled in each program.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Alignment Files

The eleven model alignment files contain the point-in-time eligibility and alignment status of model beneficiaries, and a list of eligible-but-not-enrolled patients for participating practice reporting. These alignment validation files, also known as Enrollment, Validation, Alignment, and Adjudication (EVAA) files, were generated semi-annually throughout the duration of the model, each October and April. There were a total of 10 EVAA analytical cycles, between October 2017 and April 2022. The model alignment file names indicate the cycle number (01-10) and the year and month of the cycle. In addition, there is a final model alignment file that represents the alignment status of model beneficiaries at the end of the model.

What does this file include? (variable highlights)

  • Model-Assigned Practice ID
  • Practice Name
  • Practice TIN
  • Unique Model-Assigned Patient ID
  • Aligned Flag
  • Eligible Flag
  • Patient Status Change Reason Code

A record represents the eligibility and alignment status of a beneficiary.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Provider List File

The Provider List file contains the list of all NPIs enrolled in the model, including the activation and deactivation dates.

What does this file include? (variable highlights)

  • NPI of the Participating Provider
  • Provider First and Last Name
  • Model-Assigned Practice ID the provider is associated with
  • Practice Name
  • Practice TIN

A record represents a provider (NPI) who is enrolled in the registry.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Practice List File

The Practice List file contains the list of all practices enrolled in the model, including an indicator if the practice is active and the number of files submitted for the practice.

What does this file include? (variable highlights)

  • Model-Assigned Practice ID
  • Practice Billing TIN
  • Practice Location
  • Comma-Separated Lists of Affiliated Practice NPIs and CCNs (Facility Numbers)

A record represents a single physician practice (billing TIN).

The practice TIN can be linked to other Medicare data that contains TINs.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Visit File

The Visit file contains all data extracted to create a beneficiary visit, and includes both uploaded data and manually entered data from the model data collection registry. All generated risk scores and baseline groups are contained in this file. The file is generated at the visit level, with one row for each visit for each beneficiary.

What does this file include? (variable highlights)

  • Model-Assigned Practice ID
  • Model-Assigned Patient ID
  • Visit Date
  • Baseline CVD Risk Score
  • CVD Risk Score at the time of the visit
  • Baseline risk group (low, medium, high)

A record represents a patient at the time of a particular visit, and includes information such as visit date, baseline risk score, visit risk score, and baseline group.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Beneficiary Demographic File

The Beneficiary Demographic file contains all beneficiary demographic information entered via manual entry and upload to the model data collection registry. Additionally, partial beneficiary data that was created through the semi-annual beneficiary alignment validation process is also included and could be considered a data input method. The file is at the beneficiary level, with one record for each beneficiary. It’s possible for the same beneficiary to appear in the file twice, if two or more organizations tried to enroll the same beneficiary.

What does this file include? (variable highlights)

  • Beneficiary ID
  • Model-Assigned Patient ID
  • Patient Date of Birth
  • Patient Gender
  • Patient Race
  • Patient Ethnicity

A record represents a single beneficiary. Some beneficiaries may have more than one record if more than one organization tried to enroll them in the trial.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Final Clinical File

The Final Clinical file is a model-curated version of the information in the Raw Clinical data. Million Hearts® business rules are applied to the raw data and select information is extracted and translated into custom codes.

Note that clinical data excludes all “Incomplete” visits.

What is a clinical data element? Data fields that can be collected, utilized, or stored in various application systems.

What does this file include? (variable highlights)

  • Beneficiary ID
  • Model-Assigned Practice ID
  • Model-Assigned Patient ID
  • Provider NPI
  • Activity Date
  • Activity End Date
  • Provider NPI
  • Clinical Service Procedure Code
  • Clinical Service Procedure Modifier
  • Service Units

A record represents one clinical data element per beneficiary. Beneficiaries that have multiple clinical data elements will have multiple records.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

The NPI can be linked to other records with NPI in this dataset and other CCW Medicare data.

Million Hearts® Cardiovascular Disease Risk Reduction (Million Hearts®) Model Raw Clinical File

The Raw Clinical file contains all visit and clinical data that was uploaded to the model’s data collection registry. This data is preserved as it was uploaded, therefore it may contain data that is not relevant for the Million Hearts® registry as the measures are defined. The file is at the clinical data element level and contains one row per clinical data element per beneficiary, using industry standard codes.

Note that this file excludes all manually entered data in the Million Hearts® registry.

What does this file include? (variable highlights)

  • Beneficiary ID
  • Model-Assigned Practice ID
  • Model-Assigned Patient ID
  • Provider NPI
  • Activity Date
  • Activity End Date
  • Provider NPI
  • Clinical Service Procedure Code
  • Clinical Service Procedure Modifier
  • Service Units

A record represents one clinical data element per beneficiary. Beneficiaries that have multiple clinical data elements will have multiple records.

The Unique Model-Assigned Patient ID can be used to link to other Million Hearts® beneficiary files (demographic, visit, and alignment), but cannot link to other CCW non-Million Hearts® files.

The Model-Assigned Practice ID can be used to link all Million Hearts® data files for provider-oriented analytics. It does not link to other CCW provider data.

The Beneficiary ID can be linked to other beneficiary records in this dataset and other CCW Medicare data.

The NPI can be linked to other records with NPI in this dataset and other CCW Medicare data.