data.cms.gov health datasets

Provider of Services File - OTHER - March 2013 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
Provider of Services File - CLIA - December 2014 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab. Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016. Data Issue 1: Incorrect Certificate Data Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used. Fields SHORT DESCRIPTION LEN START END TYPE Application Type Code 1 475 475 VARCHAR2 Description: Type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD CLIA Certificate Effective Date 8 478 485 DATE Description: Start date of the certificate. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 486 493 DATE Description: Date the certificate was generated for mailing. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 494 494 VARCHAR2 Description: Type of certificate issued to the laboratory, based on the application type code. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD CLIA Termination Code 2 529 530 VARCHAR2 Description: Identifies a laboratory's active or terminated status. If terminated, identifies the reason. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-TRMNTN-CD Data Issue 2: Labs Never Certified Included in POS CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
Provider of Services File - CLIA - December 2015 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab. Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016. Data Issue 1: Incorrect Certificate Data Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used. Fields SHORT DESCRIPTION LEN START END TYPE Application Type Code 1 475 475 VARCHAR2 Description: Type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD CLIA Certificate Effective Date 8 478 485 DATE Description: Start date of the certificate. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 486 493 DATE Description: Date the certificate was generated for mailing. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 494 494 VARCHAR2 Description: Type of certificate issued to the laboratory, based on the application type code. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD CLIA Termination Code 2 529 530 VARCHAR2 Description: Identifies a laboratory's active or terminated status. If terminated, identifies the reason. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-TRMNTN-CD Data Issue 2: Labs Never Certified Included in POS CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
CPC Initiative: Participating Primary Care Practices | Ohio & Kentucky: Cincinnati-Dayton Region - The Comprehensive Primary Care (CPC) initiative is a multi-payer initiative fostering collaboration between public and private health care payers to strengthen primary care. Medicare will work with commercial and State health insurance plans and offer bonus payments to primary care doctors who better coordinate care for their patients. Primary care practices that choose to participate in this initiative will be given resources to better coordinate primary care for their Medicare patients.
Provider of Services File - CLIA - December 2012 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab. Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016. Data Issue 1: Incorrect Certificate Data Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used. Fields SHORT DESCRIPTION LEN START END TYPE Application Type Code 1 475 475 VARCHAR2 Description: Type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD CLIA Certificate Effective Date 8 478 485 DATE Description: Start date of the certificate. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 486 493 DATE Description: Date the certificate was generated for mailing. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 494 494 VARCHAR2 Description: Type of certificate issued to the laboratory, based on the application type code. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD CLIA Termination Code 2 529 530 VARCHAR2 Description: Identifies a laboratory's active or terminated status. If terminated, identifies the reason. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-TRMNTN-CD Data Issue 2: Labs Never Certified Included in POS CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
Fiscal Year (FY) 2014 Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) Improper Payment Data - The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2014 report period (claims submitted July 1, 2012 through June 30, 2013). These claims were used to calculate the FY 2014 Medicare FFS improper payment rate.
2017 Medicare Shared Savings Program Accountable Care Organizations – Map - The Medicare Shared Savings Program (or Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). Note: Data descriptions are available in the Data Dictionary on the ACOs in Your State webpage at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/ACOs-in-Your-State.html. Look for the Downloads section at the bottom of the page and open the ZIP file to see the Data Dictionary. The yellow clusters represent the number of ACOs in an area. This area may cover organizations in multiple states. Click on the cluster to view blue dots with fly outs to see actual ACO location. DISCLAIMER: This information is current as of December 2016. Changes to ACO information occurs periodically. Each ACO has the most up-to-date information about their organization. Consider using them as a resource to obtain the latest information about an ACO.
Performance Year 2018 Medicare Shared Savings Program Accountable Care Organizations – Participants - The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). DISCLAIMER: This data is the certified list of ACO participants for 2018. The ACO has the most up-to-date information. Consider contacting the ACO to obtain the latest information about their ACO participants. The names in the Par_LBN column appear as reported in the original data source.
Performance Year 2018 Medicare Shared Savings Program Accountable Care Organizations - The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). DISCLAIMER: This information is current as of January 2018. Changes to ACO information occurs periodically. Each ACO has the most up-to-date information about their organization. Consider contacting the ACO for the latest information.
Medicare Individual Provider List - PLEASE NOTE*The file uploads from 12/14, 12/21, 12/28, 01/04 and 01/11 were posted incorrectly and 80,000~ prescribers were missing from the list due to a software glitch caused by a software upgrade. The error has since been corrected and the accurate file was uploaded on 1/19/2016 In an effort to prepare the prescribers and Part D sponsors for the June 1, 2016, enforcement date, CMS is making available an enrollment file that identifies physician and eligible professional who are enrolled in Medicare in an approved or opt out status. The file contains production data but is considered a test file since the Part D prescriber enrollment requirement is not yet applicable. An updated enrollment file will be generated every two weeks and continue through the June 1, 2016 enforcement date. The file displays provider eligibility as of and after November 1, 2014 (i.e., currently enrolled, new approvals, or changes from opt-out to enrolled as of November 1, 2014). Any inactive providers or periods of inactivity for existing providers prior to November 1, 2014, will not be displayed on the enrollment file. However, any enrollments that become inactive after November 1, 2014, will be on the file with its respective end dates for that given provider. For opted out providers, the opt out flag will display a Y/N (Yes/No) value to indicate the periods the provider was opted out of Medicare. The file will include the provider’s: • National Provider Identifier (NPI); • First and Last Name; • Effective and End Dates; and • Opt Out Flag
CROSSWALK MEDICARE PROVIDER/SUPPLIER to HEALTHCARE PROVIDER TAXONOMY - This crosswalk links the types of providers and suppliers who are eligible to apply for enrollment in the Medicare program with the appropriate Healthcare Provider Taxonomy Codes. This crosswalk includes the Medicare Specialty Codes for those provider/supplier types who have Medicare Specialty Codes. The Healthcare Provider Taxonomy Code Set is available from the Washington Publishing Company (www.wpc-edi.com) and is maintained by the National Uniform Claim Committee (www.nucc.org). The code set is updated twice a year, with the updates being effective April 1 and October 1 of each year. This document reflects Healthcare Provider Taxonomy Codes effective for use on April 2, 2018. When changes are made to Medicare provider enrollment requirements, the Medicare Specialty Codes, or the Healthcare Provider Taxonomy Code Set, this document may need to be revised. NOTE: This document does not alter existing Medicare claims preparation, processing, or payment instructions, nor does it alter existing Medicare provider enrollment requirements or policies.
Medicare Provider Utilization and Payment Data: 2016 Part D Prescriber - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), with information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers. Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided. For additional limitations, please review the methodology document in the About tab.
Order and Referring - Order and Referring data file has National Provider Identifier (NPI) and legal name (last name, first name) of all physicians and non-physician practitioners who are of a type/specialty that is legally eligible to order and refer in the Medicare program and who have current enrollment records in Medicare (i.e., they have enrollment records in PECOS)
Medicare Provider Utilization and Payment Data: Physician and Other Supplier CY2013 - CPT copyright 2014 American Medical Association. All Rights Reserved. This dataset is subject to the AMA click-agreement. If you have reached this dataset without the click through agreement, please acknowledge your acceptance here: https://data.cms.gov/use-agreement?id=din4-7td8 NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers. The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (herein referred to as “Physician and Other Supplier PUF”), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS’s National Claims History (NCH) Standard Analytic Files (SAFs). The data in the Physician and Other Supplier PUF covers calendar year 2013 and contains 100% final-action (i.e., all claim adjustments have been resolved) physician/supplier Part B non-institutional line items (excluding durable medical equipment) for the Medicare fee-for-service (FFS) population.
Monthly Pre-Existing Condition Insurance Plan Enrollment (State by State) - The Affordable Care Act created the new Pre-Existing Condition Insurance Plan (PCIP) program to make health insurance available to Americans denied coverage by private insurance companies because of a pre-existing condition. Coverage for people living with such conditions as diabetes, asthma, cancer, and HIV/AIDS has often been priced out of the reach of most Americans who buy their own insurance, and this has resulted in a lack of coverage for millions. The temporary program covers a broad range of health benefits and is designed as a bridge for people with pre-existing conditions who cannot obtain health insurance coverage in today’s private insurance market. To learn more, visit PCIP.gov or HealthCare.gov. Note: * Massachusetts and Vermont are guarantee issue states that have already implemented many of the broader market reforms included in the Affordable Care Act that take effect in 2014. Existing commercial plans offering guaranteed coverage at premiums comparable to PCIP are already available in both states.
Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year 2015 - The “Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report”, a supplement to the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, contains information on utilization, payments (Medicare allowed amount, Medicare payment, standardized Medicare payment), and submitted charges organized by NPI. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Medicare Skilled Nursing Facility (SNF) Provider Aggregate Report, CY 2014 - The Skilled Nursing Facility Utilization and Payment Public Use File (Skilled Nursing Facility PUF) provides information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility PUF contains information on utilization, payment (allowed amount, Medicare payment and standard payment), submitted charges and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Skilled Nursing Facility PUF covers calendar year 2014 and contains 100% final-action (i.e., all claim adjustments have been resolved) skilled nursing facility institutional claims for the Medicare fee-for-service (FFS) population.
Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) - FY2011 - 6/2/14 UPDATE: Original FY2011 data file has been updated to include a new column, "Average Medicare Payment." The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent more than 7 million discharges or 60 percent of total Medicare IPPS discharges. For more information, see https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2011.html.
Performance Year 2018 Medicare Shared Savings Program Accountable Care Organizations – Map - The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). Note: The yellow clusters represent the number of ACOs in an area. This area may cover organizations in multiple states. Click on the cluster to view blue dots with fly outs to see actual ACO location. DISCLAIMER: This information is current as of January 2018. Changes to ACO information occurs periodically. Each ACO has the most up-to-date information about their organization. Consider contacting the ACO for the latest information.
Comprehensive Care for Joint Replacement Model: Metropolitan Statistical Areas (MSAs) - This data set presents Metropolitan Statistical Areas (MSAs) that are participating in the Comprehensive Care for Joint Replacement Model, a proposed model to support better and more efficient care for beneficiaries undergoing the most common inpatient surgery for Medicare beneficiaries: hip and knee replacements.
Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year 2016 - The “Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report”, a supplement to the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, contains information on utilization, payments (Medicare allowed amount, Medicare payment, standardized Medicare payment), and submitted charges organized by NPI. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Medicare Provider Utilization and Payment Data: Physician and Other Supplier PUF CY2016 - CPT copyright 2015 American Medical Association. All Right Reserved. This dataset is subject to the AMA click-agreement. If you have reached this dataset without the click through agreement, please acknowledge your acceptance here: https://data.cms.gov/use-agreement/cpt-code/medicare-provider-data-2015 NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers. The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (herein referred to as “Physician and Other Supplier PUF”), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2016 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
Medicare Provider Utilization and Payment Data: Physician and Other Supplier PUF CY2015 - CPT copyright 2014 American Medical Association. All Right Reserved. This dataset is subject to the AMA click-agreement. If you have reached this dataset without the click through agreement, please acknowledge your acceptance here: https://data.cms.gov/use-agreement/cpt-code/medicare-provider-data-2015 NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers. The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (herein referred to as “Physician and Other Supplier PUF”), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2015 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year 2014 - The “Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report”, a supplement to the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, contains information on utilization, payments (Medicare allowed amount, Medicare payment, standardized Medicare payment), and submitted charges organized by NPI. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Database of HPSA and Low-Income ZIP Codes for Issuers Subject to the Alternate ECP Standard for the purposes of QHP Certification - Database of HPSA and Low-Income ZIP Codes for Issuers Subject to the Alternate ECP Standard for the purposes of QHP Certification
CMS Innovation Center Model Participants - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Performance Year 2018 Medicare Shared Savings Program Accountable Care Organizations – SNF Affiliates - The Medicare Shared Savings Program (Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). DISCLAIMER: This data is the certified list of ACO SNF Affiliates for 2018. The ACO has the most up-to-date information. Consider contacting the ACO to obtain the latest information about their SNF Affiliates. The names in the Aff_LBN column appear as reported in the original data source.
Medicare Part D Opioid Prescriber Summary File 2015 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Part D Opioid Prescriber Summary File, which presents information on the individual opioid prescribing rates of health providers that participate in Medicare Part D program. This file is a prescriber-level data set that provides data on the number and percentage of prescription claims (includes new prescriptions and refills) for opioid drugs, and contains information on each provider’s name, specialty, state, and ZIP code. This summary file was derived from the 2015 Part D Prescriber Summary Table (Documentation available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Prescriber_Methods.pdf)
Medicare Hospice Use and Spending by State Aggregate Report, CY 2015 - The Hospice Utilization and Payment Public Use File (Hospice PUF) provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2015 and contains 100% final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
Medicare Referring Provider DMEPOS NPI Aggregate table, CY2016 - The “Medicare Referring Provider DMEPOS NPI Aggregate table” contains information on utilization, payment, and submitted charges organized by Referring Provider NPI. Separate sub totals for durable medical equipment services, prosthetic and orthotic services and drug and nutritional services are included in addition to overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Medicare Skilled Nursing Facilities Therapy Minutes Aggregate Table, CY 2015 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Skilled Nursing Facility Utilization and Payment Public Use File (herein referred to as “Skilled Nursing Facility PUF”), with information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility PUF contains information on utilization, payment (allowed amount, Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Skilled Nursing Facility PUF covers calendar year 2015 and contains 100% final-action (i.e., all claim adjustments have been resolved) skilled nursing facility institutional claims for the Medicare fee-for-service (FFS) population. Although the Skilled Nursing Facility PUF has a wealth of payment and utilization information about skilled nursing facility services, the dataset also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual skilled nursing facilities. The file only contains cost and utilization information. Additionally, the data are not risk adjusted and thus do not account for differences in the underlying severity of disease of patient populations treated by providers. For additional limitations, please review the methodology document available in the About tab.
Medicare Hospice Use and Spending by Provider Aggregate Report, CY 2014 - The Hospice Utilization and Payment Public Use File (Hospice PUF) provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2014 and contains 100% final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
Moratoria Provider Services and Utilization Map Data v1.1 2016-07-15 - ** Visit the tool at https://data.cms.gov/moratoria-data ** The Moratoria Provider Services and Utilization Data Tool includes interactive maps and a dataset that shows national, state and county level provider services and utilization data for selected health service areas. The data provide information on the number of Medicare providers servicing a geographic region,and the number of Medicare beneficiaries who use a health service area. For the ambulance and home health service areas, moratoria regions at the state and county level are clearly indicated. Provider services and utilization data by geographic regions are easily compared using the interactive map.
Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year 2012 - The “Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report”, a supplement to the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, contains information on utilization, payments (Medicare allowed amount, Medicare payment, standardized Medicare payment), and submitted charges organized by NPI. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Medicare Hospice Use and Spending by Provider Aggregate Report, CY 2016 - The Hospice Utilization and Payment Public Use File (Hospice PUF) provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2015 and contains 100% final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
State Summary of Inpatient Charge Data by Medicare Severity Diagnosis Related Group (MS-DRG), FY2016 - The Inpatient Utilization and Payment state summary data provides information on inpatient discharges for Medicare fee-for-service beneficiaries. The Inpatient PUF includes information on utilization, payment (total payment and Medicare payment), and hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments.
Medicare Part D Opioid Prescriber Summary File 2014 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Part D Opioid Prescriber Summary File, which presents information on the individual opioid prescribing rates of health providers that participate in Medicare Part D program. This file is a prescriber-level data set that provides data on the number and percentage of prescription claims (includes new prescriptions and refills) for opioid drugs, and contains information on each provider’s name, specialty, state, and ZIP code. This summary file was derived from the 2014 Part D Prescriber Summary Table (Documentation available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Prescriber_Methods.pdf)
Moratoria Provider Services and Utilization Dataset v1.1 2016-07-15 - ** Visit the tool at https://data.cms.gov/moratoria-data ** The Moratoria Provider Services and Utilization Data Tool includes interactive maps and a dataset that shows national, state and county level provider services and utilization data for selected health service areas. The data provide information on the number of Medicare providers servicing a geographic region and the number of Medicare beneficiaries who use a health service area. For the ambulance and home health service areas, moratoria regions at the state and county level are clearly indicated. Provider services and utilization data by geographic regions are easily compared using the interactive map.
National Summary of Inpatient Charge Data by Medicare Severity Diagnosis Related Group (MS-DRG), FY2016 - The Inpatient Utilization and Payment national summary data provides information on inpatient discharges for Medicare fee-for-service beneficiaries. The Inpatient PUF includes information on utilization, payment (total payment and Medicare payment), and hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments.
Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report, Calendar Year 2013 - The “Medicare Physician and Other Supplier National Provider Identifier (NPI) Aggregate Report”, a supplement to the Medicare Provider Utilization and Payment Data: Physician and Other Supplier data, contains information on utilization, payments (Medicare allowed amount, Medicare payment, standardized Medicare payment), and submitted charges organized by NPI. Sub-totals for medical type services and drug type services are included as well as overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Medicare Part D Opioid Prescriber Summary File 2016 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Part D Opioid Prescriber Summary File, which presents information on the individual opioid prescribing rates of health providers that participate in Medicare Part D program. This file is a prescriber-level data set that provides data on the number and percentage of prescription claims (includes new prescriptions and refills) for opioid drugs, and contains information on each provider’s name, specialty, state, and ZIP code. This summary file was derived from the 2016 Part D Prescriber Summary Table (Documentation available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Prescriber_Methods.pdf)
Medicare Shared Savings Program Accountable Care Organizations Performance Year 2014 Results - Based upon Medicare Shared Savings Program Accountable Care Organizations Performance Year 2014 Results This dataset presents data on Calendar Year 2014 financial reconciliation and quality performance results for ACOs with 2012, 2013 and 2014 agreement start dates. ACOs that generated savings earned a performance payment if they met the quality standard. Quality performance for ACOs with 2014 start dates that are in their first performance year is based on complete and accurate reporting of all required quality measures for Calendar Year 2014. Notes: 1 - (Gross) Generated savings: Total savings (first to last dollar) for ACOs whose savings equaled or exceeded their minimum savings rates (variable based on ACO size under Track 1 and flat 2% under Track 2). This amount does not account for the application of the ACO’s final sharing rate based on quality performance, reduction due to sequestration or repayment of advance payments. 2 - (Gross) Generated losses: Total losses (first to last dollar) for Track 2 ACOs whose losses equaled or exceeded their minimum loss rate (flat 2%). This amount does not account for the application of the ACO’s final sharing rate based on quality performance. 3 - Total earned shared savings: The ACO’s share of savings for ACOs whose savings equaled or exceeded their minimum savings rates, and who were eligible for a performance payment because they met the program’s quality performance standard. This amount accounts for the application of the ACO’s final sharing rate based on quality performance (up to 50% under Track 1 and up to 60% under Track 2), as well as the reduction in performance payment due to sequestration. This amount does not account for repayment of advance payments. 4 - Total earned shared losses: The ACO’s share of losses for Track 2 ACOs whose losses equaled or exceeded their minimum loss rate (flat 2%). This amount accounts for the application of the ACO’s final loss sharing rate (which does not exceed 60%) based on quality performance. 5 - Successfully Reported Quality: ACOs are considered to have successfully reported quality if they completely reported in 2014. 6 - Quality Score: ACOs with 2014 start dates will have a “P4R” (Pay for Reporting) displayed for the Quality Score to reflect that their quality performance is based on complete and accurate reporting. For more information on how the Overall Quality Score was determined for ACOs with an Agreement Start Date in 2012 or 2013, please refer to the Medicare Shared Savings Program Quality Measure Benchmarks for the 2014 Reporting Year document posted on the Shared Savings Program website http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Quality_Measures_Standards.html. ACO-1 through ACO-33: ACOs that did not successfully report CAHPS measures in 2014 will have a dash "-" displayed for CAHPS measures (ACO-1 through ACO-7). ACOs that did not successfully report GPRO Web Interface measures in 2014 will have a dash "-" displayed for GPRO Web Interface measures (ACO-12 through ACO-33). These measure fields appear as blank cells in the downloaded file (the dash is not displayed). For measure ACO-11, if no providers were eligible for this measure due to the measure's inclusion/exclusion criteria, then "N/A" (Not Applicable) will appear in place of a performance rate. For measures ACO-12 through ACO-33, if no beneficiaries were eligible for this measure due to the measure's inclusion/exclusion criteria, then an "N/A" (Not Applicable) will appear in the place of a performance rate. ^Measures marked with a caret (^) are measures where a lower performance rate is indicative of better quality. For a crosswalk of ACO measure numbers to ACO measure names, please consult the following table: http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/Downloads/ACO-Shared-Savings-Progr
Medicare Skilled Nursing Facility (SNF) Provider Aggregate Report, CY 2015 - The Skilled Nursing Facility Utilization and Payment Public Use File (Skilled Nursing Facility PUF) provides information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility PUF contains information on utilization, payment (allowed amount, Medicare payment and standard payment), submitted charges and beneficiary demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Skilled Nursing Facility PUF covers calendar year 2014 and contains 100% final-action (i.e., all claim adjustments have been resolved) skilled nursing facility institutional claims for the Medicare fee-for-service (FFS) population.
Medicare Hospice Use and Spending by State Aggregate Report, CY2016 - The Hospice Utilization and Payment Public Use File (Hospice PUF) provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2016 and contains 100% final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
FFS Medicare 30 Day Readmission Rate PUF - The hospital readmission rate PUF presents nation-wide information about inpatient hospital stays that occurred within 30 days of a previous inpatient hospital stay (readmissions) for Medicare fee-for-service beneficiaries. The readmission rate equals the number of inpatient hospital stays classified as readmissions divided by the number of index stays for a given month. Index stays include all inpatient hospital stays except those where the primary diagnosis was cancer treatment or rehabilitation. Readmissions include stays where a beneficiary was admitted as an inpatient within 30 days of the discharge date following a previous index stay, except cases where a stay is considered always planned or potentially planned. Planned readmissions include admissions for organ transplant surgery, maintenance chemotherapy/immunotherapy, and rehabilitation. This dataset has several limitations. Readmissions rates are unadjusted for age, health status or other factors. In addition, this dataset reports data for some months where claims are not yet final. Data published for the most recent six months is preliminary and subject to change. Final data will be published as they become available, although the difference between preliminary and final readmission rates for a given month is likely to be less than 0.1 percentage point. Data Source: The primary data source for these data is the CMS Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For complete information regarding data in the CCW, visit http://ccwdata.org/index.php. Study Population: Medicare fee-for-service beneficiaries with inpatient hospital stays.
Medicare Hospice Use and Spending by State Aggregate Report, CY 2014 - The Hospice Utilization and Payment Public Use File (Hospice PUF) provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2014 and contains 100% final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
Medicare Skilled Nursing Facilities Therapy Minutes Aggregate Table, CY 2014 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Skilled Nursing Facility Utilization and Payment Public Use File (herein referred to as “Skilled Nursing Facility PUF”), with information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility PUF contains information on utilization, payment (allowed amount, Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Skilled Nursing Facility PUF covers calendar year 2014 and contains 100% final-action (i.e., all claim adjustments have been resolved) skilled nursing facility institutional claims for the Medicare fee-for-service (FFS) population. Although the Skilled Nursing Facility PUF has a wealth of payment and utilization information about skilled nursing facility services, the dataset also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual skilled nursing facilities. The file only contains cost and utilization information. Additionally, the data are not risk adjusted and thus do not account for differences in the underlying severity of disease of patient populations treated by providers. For additional limitations, please review the methodology document available in the About tab.
Medicare Part D Opioid Prescriber Summary File 2013 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Part D Opioid Prescriber Summary File, which presents information on the individual opioid prescribing rates of health providers that participate in Medicare Part D program. This file is a prescriber-level data set that provides data on the number and percentage of prescription claims (includes new prescriptions and refills) for opioid drugs, and contains information on each provider’s name, specialty, state, and ZIP code. This summary file was derived from the 2013 Part D Prescriber Summary Table (Documentation available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Prescriber_Methods.pdf)
Medicare Referring Provider DMEPOS NPI Aggregate table, CY2015 - The “Medicare Referring Provider DMEPOS NPI Aggregate table” contains information on utilization, payment, and submitted charges organized by Referring Provider NPI. Separate sub totals for durable medical equipment services, prosthetic and orthotic services and drug and nutritional services are included in addition to overall utilization, payment and charges. In addition, beneficiary demographic and health characteristics are provided which include age, sex, race, Medicare and Medicaid entitlement, chronic conditions and risk scores.
Medicare Home Health Provider Aggregate Table, CY 2013 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Home Health Agency Utilization and Payment Public Use File, with information on services provided to Medicare beneficiaries by home health agencies. This table is a provider level table that contains information on utilization and payment organized by home health agency. The variables in this table are divided into non-LUPA and LUPA episodes. This table also contains average outlier payments as a percent of Medicare payment amounts for non-LUPA episodes only.
Inpatient Prospective Payment System (IPPS) Provider Summary for All Diagnosis-Related Groups (DRG) - FY2016 - The Inpatient Utilization and Payment Public Use File (Inpatient PUF) provides information on inpatient discharges for Medicare fee-for-service beneficiaries. The Inpatient PUF includes information on utilization, payment (total payment and Medicare payment), and hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments. The PUF is organized by hospital and Medicare Severity Diagnosis Related Group (MS-DRG) and covers Fiscal Year (FY) 2016. MS-DRGs included in the PUF represent more than 7 million discharges or 75 percent of total Medicare IPPS discharges.
Medicare Hospice Use and Spending by Provider Aggregate Report, CY 2015 - The Hospice Utilization and Payment Public Use File (Hospice PUF) provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number) and state. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2015 and contains 100% final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
Provider of Services File - OTHER - September 2015 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For more information go to: http://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Provider-of-Services/index.html
Provider of Services File - CLIA - September 2013 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab. Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016. Data Issue 1: Incorrect Certificate Data Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used. Fields SHORT DESCRIPTION LEN START END TYPE Application Type Code 1 475 475 VARCHAR2 Description: Type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD CLIA Certificate Effective Date 8 478 485 DATE Description: Start date of the certificate. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 486 493 DATE Description: Date the certificate was generated for mailing. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 494 494 VARCHAR2 Description: Type of certificate issued to the laboratory, based on the application type code. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD CLIA Termination Code 2 529 530 VARCHAR2 Description: Identifies a laboratory's active or terminated status. If terminated, identifies the reason. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-TRMNTN-CD Data Issue 2: Labs Never Certified Included in POS CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
2013 Physician/Supplier Procedure Summary - The Physician/Supplier Procedure Summary (PSPS) file is a summary of calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The file is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service. The summarized fields are total submitted services and charges, total allowed services and charges, total denied services and charges, and total payment amounts. The record layout in the Downloads section below provides additional details on the file.
Fiscal Year (FY) 2015 Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) Improper Payment Data - The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2015 report period (claims submitted July 1, 2013 through June 30, 2014). These claims were used to calculate the FY 2015 Medicare FFS improper payment rate.
Fiscal Year (FY) 2013 Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) Improper Payment Data - The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2013 report period (claims submitted July 1, 2011 through June 30, 2012). These claims were used to calculate the FY 2013 Medicare FFS improper payment rate.
Provider of Services - OTHER - March 2016 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly.
Strong Start Facilities - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Fiscal Year (FY) 2011 Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) Improper Payment Data - The dataset includes detailed information on Medicare FFS claims that underwent CERT medical review for the FY 2011 report period (claims submitted January 1, 2010 through December 31, 2010). These claims were used to calculate the FY 2011 Medicare FFS improper payment rate.
Medicare Home Health Agency (HHA) HHRG Aggregate Report, CY 2014 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Home Health Agency Utilization and Payment Public Use File, with information on services provided to Medicare beneficiaries by home health agencies. This table contains information on utilization and payment organized by home health resource group (HHRG).
Medicare Home Health Agency (HHA) HHRG by State Aggregate Report, CY 2014 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Home Health Agency Utilization and Payment Public Use File, with information on services provided to Medicare beneficiaries by home health agencies. This table contains information on utilization and payment organized by state and home health resource group (HHRG).
Medicare HHRG by State Aggregate Table, CY 2013 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Home Health Agency Utilization and Payment Public Use File, with information on services provided to Medicare beneficiaries by home health agencies. This table contains information on utilization and payment organized by state and home health resource group (HHRG).
Medicare Home Health Agency (HHA) Provider by HHRG Aggregate Report, CY 2014 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Home Health Agency Utilization and Payment Public Use File, with information on services provided to Medicare beneficiaries by home health agencies. This table contains information on utilization and payment organized by home health agency and home health resource group (HHRG).
Medicare Home Health Agency (HHA) Provider by HHRG Aggregate Report, CY 2015 - The Home Health Agency PUF presents summarized information on services provided to Medicare beneficiaries by home health agencies. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service.
CMS Innovation Center Model Participants - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Provider of Services - CLIA - March 2016 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016. Data Issue 1: Incorrect Certificate Data Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used. Fields SHORT DESCRIPTION LEN START END TYPE Application Type Code 1 475 475 VARCHAR2 Description: Type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD CLIA Certificate Effective Date 8 478 485 DATE Description: Start date of the certificate. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 486 493 DATE Description: Date the certificate was generated for mailing. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 494 494 VARCHAR2 Description: Type of certificate issued to the laboratory, based on the application type code. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD CLIA Termination Code 2 529 530 VARCHAR2 Description: Identifies a laboratory's active or terminated status. If terminated, identifies the reason. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-TRMNTN-CD Data Issue 2: Labs Never Certified Included in POS CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
Medicare Home Health Agency (HHA) Provider Aggregate Report, CY 2015 - The Home Health Agency PUF presents summarized information on services provided to Medicare beneficiaries by home health agencies. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service.
State Innovation Models Initiative: Round Two Awards - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Provider of Services - CLIA - June 2016 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly.
Provider of Services File - OTHER - March 2018 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
State Innovation Model Initiative: All Awardees - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Provider of Services File - OTHER - September 2013 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
Value Modifier PUF Performance Year 2013 - Performance Year 2013 (Payment Year 2015). Value Modifier (VM) Public Use File (PUF) - The Centers for Medicare and Medicaid Services (CMS) has created a standard analytical file intended to promote transparency. For each VM performance year, CMS will publish a PUF that contains VM performance results of de-identified practices that were subject to the VM program. CMS provides supporting documentation for each PUF that contains the field name, length, type, label, description, and notes for each variable included in the PUF.
Part D Prescriber National Summary Report, Calendar Year 2014 - The Part D Prescriber National Summary Report, Calendar Year 2014 provides information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.
CPC Initiative: Participating Primary Care Practices | Arkansas: Statewide - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Value Modifier PUF Performance Year 2015 - Performance Year 2015 (Payment Year 2017). Value Modifier (VM) Public Use File (PUF) - The Centers for Medicare and Medicaid Services (CMS) has created a standard analytical file intended to promote transparency. For each VM performance year, CMS will publish a PUF that contains VM performance results of de-identified practices that were subject to the VM program. CMS provides supporting documentation for each PUF that contains the field name, length, type, label, description, and notes for each variable included in the PUF.
Provider of Services - OTHER - September 2017 - The POS file contains data on characteristics of hospitals and other types of healthcare facilities, including the name and address of the facility and the type of Medicare services the facility provides, among other information. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. The data is an invaluable resource to a variety of stakeholders, including researchers and application developers.
National Summary of Outpatient Charge Data by select 30 APCs, CY2011 - The Outpatient Utilization and Payment national summary data presents information on common outpatient services provided to Medicare fee-for-service beneficiaries. The Outpatient PUF presents information on utilization, payment, and estimated hospital-specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2011. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
Medicare Home Health Provider by HHRG Aggregate Table, CY 2013 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Home Health Agency Utilization and Payment Public Use File, with information on services provided to Medicare beneficiaries by home health agencies. This table contains information on utilization and payment organized by home health agency and home health resource group (HHRG).
Provider of Services File - CLIA - March 2018 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab. Two data issues in the CLIA POS file have been resolved as of the 2nd Quarter 2016 file. The data issues occurred in CLIA POS files starting with the 2nd Quarter 2011 file through 1st quarter 2016. Data Issue 1: Incorrect Certificate Data Certificate data in the CLIA POS file should always come from the lab's current effective certificate. Due to a sorting issue, certificate data from a lab's pending or historical certificates were used and the lab's current effective certificate data was not used. Fields SHORT DESCRIPTION LEN START END TYPE Application Type Code 1 475 475 VARCHAR2 Description: Type of CLIA certificate applied for by a laboratory. SAS Name: APLCTN_TYPE_CD COBOL Name: APLCTN-TYPE-CD CLIA Certificate Effective Date 8 478 485 DATE Description: Start date of the certificate. SAS Name: CRTFCT_EFCTV_DT COBOL Name: CRTFCT-EFCTV-DT CLIA Certificate Mailed Date 8 486 493 DATE Description: Date the certificate was generated for mailing. SAS Name: CRTFCT_MAIL_DT COBOL Name: CRTFCT-MAIL-DT CLIA Certificate Type Code 1 494 494 VARCHAR2 Description: Type of certificate issued to the laboratory, based on the application type code. SAS Name: CRTFCT_TYPE_CD COBOL Name: CRTFCT-TYPE-CD CLIA Termination Code 2 529 530 VARCHAR2 Description: Identifies a laboratory's active or terminated status. If terminated, identifies the reason. SAS Name: CLIA_TRMNTN_CD COBOL Name: CLIA-TRMNTN-CD Data Issue 2: Labs Never Certified Included in POS CLIA providers that have never paid nor received a CLIA certificate should not be included in CLIA POS.
Medicare Advantage Value-Based Insurance Design Model - View - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Provider of Services File - OTHER - June 2013 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
Medicare Provider Utilization and Payment Data: Part D Prescriber Summary Table CY2015 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), with information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers. Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided. For additional limitations, please review the methodology document in the About tab.
Part D Prescriber National Summary Report, Calendar Year 2015 - The Part D Prescriber National Summary Report, Calendar Year 2015 provides information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers.
Medicare National HCPCS Aggregate Summary Table CY2015 - The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. The data in the Physician and Other Supplier PUF covers calendar year 2015 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
Medicare Resource Utilization Group (RUG) by State Aggregate Table, CY 2015 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Skilled Nursing Facility Utilization and Payment Public Use File (herein referred to as “Skilled Nursing Facility PUF”), with information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility PUF contains information on utilization, payment (allowed amount, Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Skilled Nursing Facility PUF covers calendar year 2015 and contains 100% final-action (i.e., all claim adjustments have been resolved) skilled nursing facility institutional claims for the Medicare fee-for-service (FFS) population. Although the Skilled Nursing Facility PUF has a wealth of payment and utilization information about skilled nursing facility services, the dataset also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual skilled nursing facilities. The file only contains cost and utilization information. Additionally, the data are not risk adjusted and thus do not account for differences in the underlying severity of disease of patient populations treated by providers. For additional limitations, please review the methodology document available in the About tab.
Comprehensive ESRD Care Model - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Medicare Home Health Agency (HHA) Provider Aggregate Report, CY 2016 - The Home Health Agency PUF presents summarized information on services provided to Medicare beneficiaries by home health agencies. It contains information on utilization, payment (Medicare payment and Medicare standardized payment), submitted charges, and demographic and chronic condition indicators organized by CMS Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service.
NPPES Deactivated NPI Report - The Deactivated NPI report contains NPPES data (NPI and Deactivation date) on all current deactivated NPIs in NPPES since May 23, 2005. Each monthly report will contain the cumulative list of NPIs that have a current status of ‘Deactivated’ in NPPES. (Reactivated NPIs will be removed from the NPPES Monthly Deactivated NPI Reports.)
Provider of Services File - OTHER - June 2018 - The POS file consists of two data files, one for CLIA labs and one for 18 other provider types. The file names are CLIA and OTHER. If downloading the file, note it is fairly large (125MB in CSV). The POS Extract is created from the QIES (Quality Improvement Evaluation System) database. These data include provider number, name, and address and characterize the participating institutional providers. The data are collected through the Centers for Medicare & Medicaid Services (CMS) Regional Offices. The file contains an individual record for each Medicare-approved provider and is updated quarterly. For a list of provider types, layout files, and how to order previous annual files, please see the Source Link in the About tab.
Outpatient Prospective Payment System (OPPS) Provider Summary for 30 Selected Ambulatory Payment Classification (APC) Groups - CY2011 - A provider level summary of Outpatient Prospective Payment System (OPPS) average estimated submitted charges and average Medicare Payments for 30 selected Ambulatory Payment Classification (APC) Groups. 9/04/2013 UPDATE: As a result of using the OPPS ratesetting process to develop the summary of outpatient charge and payment data, we inadvertently excluded claims data for visit APCs 0604 (“Level 1 Hospital Clinic Visits”) and 0607 (“Level 4 Hospital Clinic Visits”). The revised outpatient data reflects changes to correct this, with volume increases in the summarized data for APCs 0604 and 0607.
Medicare Referring DMEPOS HCPCS National Aggregate table CY2016 - The 2016 Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) National Aggregate table presents information on DMEPOS products and services provided to Medicare beneficiaries ordered by physicians and other healthcare professionals. The data in the Referring Provider DMEPOS PUF covers calendar year 2016 and contains final-action (i.e., all claim adjustments have been resolved) Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population.
Medicare Provider Utilization and Payment Data: 2013 Part D Prescriber - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File (PUF), with information on prescription drugs prescribed by individual physicians and other health care providers and paid for under the Medicare Part D Prescription Drug Program. The Part D Prescriber PUF is based on information from CMS’s Chronic Conditions Data Warehouse, which contains Prescription Drug Event records submitted by Medicare Advantage Prescription Drug (MAPD) plans and by stand-alone Prescription Drug Plans (PDP). The dataset identifies providers by their National Provider Identifier (NPI) and the specific prescriptions that were dispensed at their direction, listed by brand name (if applicable) and generic name. For each prescriber and drug, the dataset includes the total number of prescriptions that were dispensed, which include original prescriptions and any refills, and the total drug cost. The total drug cost includes the ingredient cost of the medication, dispensing fees, sales tax, and any applicable administration fees and is based on the amount paid by the Part D plan, Medicare beneficiary, government subsidies, and any other third-party payers. Although the Part D Prescriber PUF has a wealth of information on payment and utilization for Medicare Part D prescriptions, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice or all of Medicare as it only includes information on beneficiaries enrolled in the Medicare Part D prescription drug program (i.e., approximately two-thirds of all Medicare beneficiaries). In addition, the data are not intended to indicate the quality of care provided. For additional limitations, please review the methodology document in the About tab.
Medicare Referring Provider DMEPOS NPI Aggregate table, CY2013 - The 2013 Referring Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Public Use File (herein referred to as “Referring Provider DMEPOS PUF”) presents information on DMEPOS products and services provided to Medicare beneficiaries ordered by physicians and other healthcare professionals. The Referring Provider DMEPOS PUF contains data on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code and supplier rental indicator. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Referring Provider DMEPOS PUF covers calendar year 2013 and contains final-action (i.e., all claim adjustments have been resolved) Part B non-institutional DMEPOS line items for the Medicare fee-for-service (FFS) population. While the Referring Provider DMEPOS PUF has a wealth of information on payment and utilization for Medicare DMEPOS services, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. For additional limitations, please review the methodology document available below.
Medicare National HCPCS Aggregate Summary Table CY2014 - The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
2012 Physician/Supplier Procedure Summary - The Physician/Supplier Procedure Summary (PSPS) file is a summary of calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The file is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service. The summarized fields are total submitted services and charges, total allowed services and charges, total denied services and charges, and total payment amounts. The record layout in the Downloads section below provides additional details on the file.
Million Hearts Cardiovascular Disease Risk Reduction Model - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
Medicare Care Choices Model - [Data Formatted for Mapping] The Innovation Center develops new payment and service delivery models in accordance with the requirements of section 1115A of the Social Security Act. Additionally, Congress has defined – both through the Affordable Care Act and previous legislation – a number of specific demonstrations to be conducted by CMS.
2010 Physician/Supplier Procedure Summary - The Physician/Supplier Procedure Summary (PSPS) file is a summary of calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The file is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service. The summarized fields are total submitted services and charges, total allowed services and charges, total denied services and charges, and total payment amounts. The record layout in the Downloads section below provides additional details on the file.
Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) Provider-Level Measure Rates for Four Conditions - 2017 - This data set presents hospital-level measures rates of four conditions included in the Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) payment provision – foreign object retained after surgery, blood incompatibility, air embolism, and falls and trauma – for Medicare fee-for-service discharges from July 1, 2014 through September 30, 2015. The DRA HAC measures are solely reported for hospitals’ information and quality improvement purposes and are not a part of the HAC Reduction Program. An FAQ document that includes general information about the public reporting, measure methodology, and the calculation process for hospitals’ DRA HAC measure rates is located on the CMS website in the Downloads section at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalAcqCond/EducationalResources.html
Physician & Other Supplier 2014 by Provider Type - CPT copyright 2014 American Medical Association. All Right Reserved. This dataset is subject to the AMA click-agreement. If you have reached this dataset without the click through agreement, please acknowledge your acceptance here: https://data.cms.gov/use-agreement/cpt-code/medicare-provider-data-2014 NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers. The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (herein referred to as “Physician and Other Supplier PUF”), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
2017 Medicare Shared Savings Program Organizations - The Medicare Shared Savings Program (or Shared Savings Program) facilitates coordination among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing the growth in health care costs. Eligible providers, hospitals, and suppliers may apply to participate in the Shared Savings Program by creating or participating in an Accountable Care Organization (ACO). Note: Data descriptions are available in the Data Dictionary on the ACOs in Your State webpage at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/sharedsavingsprogram/ACOs-in-Your-State.html. Look for the Downloads section at the bottom of the page and open the ZIP file to see the Data Dictionary. DISCLAIMER: This information is current as of December 2016. Changes to ACO information occurs periodically. Each ACO has the most up-to-date information about their organization. Consider using them as a resource to obtain the latest information about an ACO.
FY 2018 Facility Level Dialysis Facility Reports - This dataset provides the End Stage Renal Disease Facility level data as presented on the Dialysis Facility Report for FY 2018
Medicare Skilled Nursing Facilities Provider Aggregate Table, CY 2013 - The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Skilled Nursing Facility Utilization and Payment Public Use File (herein referred to as “Skilled Nursing Facility PUF”), with information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility PUF contains information on utilization, payment (allowed amount, Medicare payment and standard payment), and submitted charges organized by CMS Certification Number (6-digit provider identification number), Resource Utilization Group (RUG), and state of service. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Skilled Nursing Facility PUF covers calendar year 2013 and contains 100% final-action (i.e., all claim adjustments have been resolved) skilled nursing facility institutional claims for the Medicare fee-for-service (FFS) population. Although the Skilled Nursing Facility PUF has a wealth of payment and utilization information about skilled nursing facility services, the dataset also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual skilled nursing facilities. The file only contains cost and utilization information. Additionally, the data are not risk adjusted and thus do not account for differences in the underlying severity of disease of patient populations treated by providers. For additional limitations, please review the methodology document in the about table.
2015 Physician Provider Type Aggregate - CPT copyright 2014 American Medical Association. All Right Reserved. This dataset is subject to the AMA click-agreement. If you have reached this dataset without the click through agreement, please acknowledge your acceptance here: https://data.cms.gov/use-agreement/cpt-code/medicare-provider-data-2015 NOTE: This is a very large dataset so some views and actions will take some time to load, particularly in older browsers. The Centers for Medicare & Medicaid Services (CMS) has prepared a public data set, the Provider Utilization and Payment Data Physician and Other Supplier Public Use File (herein referred to as “Physician and Other Supplier PUF”), with information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2015 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

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