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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…
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 useful. The purpose of this article is to help you understand these variables and we present the completeness of these data to assist researchers who are designing research studies using Medicare FFS claims and Encounter data.
This article provides a link and overview of the document on finder and crosswalk files written by the CMS data distributor, HealthAPT.
Medicare managed care enrollment has fluctuated over the years and is a frequently requested statistic. Often researchers are interested in penetration rates or the percentage of Medicare beneficiaries enrolled in a Medicare managed care plan. These plans are also referred to as Medicare Part C, Medicare Advantage (MA), or Medicare Health Maintenance Organizations (HMOs).
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 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.
This article provides resources for the assessment of the quantity and quality of managed care organization (MCO) encounter data in the Medicaid Analytic eXtract (MAX) 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 used in Medicare claims files.
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.