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).

Understanding the Data

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This presentation provides background information about the cost reports that will help researchers understand the cost report data.  This presentation includes a description of how cost reports are processed and how that impacts the data. This presentation also describes common issues researchers face when using the cost reports and options for dealing with those issues.

Medicare Cost Report Download

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This presentation describes where to find the Medicare cost report downloads, what is contained within each data file, and the definitions used to create the download. This presentation includes a description of the resource documents that are essential in order to start using the data.

Medicare Cost Report Resources

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The Medicare cost reports can be downloaded from the CMS website.  CMS provides several documents to aid with the use of the cost reports. This presentation describes each resource and explains how to use each.  Also, it provides links to other important resource documents that will help researchers understand and use the Medicare cost reports.

Geographic Variation in Medicare Spending

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This presentation reviews the importance of understanding the factors contributing to geographic variation in Medicare spending.

Specifically, objectives include:

  • Reviewing how Medicare adjusts reimbursement levels by geographic region, teaching affiliations, etc.
  • Understanding the importance of readjusting cost estimates so that high costs represent differences in intensity of services rather than differences in Medicare reimbursement levels and/or health status

Definitions of 'Cost' in Medicare Utilization Files

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For each of the CMS claim file types, the variables used in calculating costs for CMS covered services is reviewed. Calculations are defined by 1) what Medicare reimbursed; 2) the beneficiary's responsibility; 3) other primary payers, and then 4) total due to the provider. The presentation also includes issues to be considered when calculating costs.

CMS Payment Systems and Resources for 'Costing'

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Understanding of the CMS payment systems will assist the researcher in knowing how services are reiumbursed and what to expect in the data when costing services. This presentation will provide a historical review of CMS payment systems for all the claims data files, discuss details of calculating acute hospital MS-DRG payments, and review resources for determining 'cost' of services.