The Hospice file contains claims submitted by Medicare hospice providers. Records are included in the file regardless of whether the beneficiary is enrolled in fee-for-service (FFS) Medicare or Medicare Advantage (Medicare managed care.) This file is based on information from the CMS form 1450 (UB04).
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The Medicare Inpatient (Encounter, Final File) contains Medicare Advantage plan paid records for inpatient hospital stays.
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The Medicare Outpatient (Encounter, Final File) contains Medicare Advantage plan paid records from a variety of outpatient providers. Examples of institutional outpatient providers include hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, comprehensive outpatient rehabilitation facilities, Federally Qualified Health Centers and community mental health centers.
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The Medicare Carrier (Encounter, Final File) includes Medicare Advantage plan paid records for professional providers, including physicians, physician assistants, clinical social workers, nurse practitioners.Records for some organizational providers are also found in the Carrier (Encounter) file. Examples include independent clinical laboratories, ambulance providers, freestanding ambulatory surgical centers and freestanding radiology centers.Researchers rarely use this file alone.
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The Medicare Skilled Nursing Facility (Encounter, Final File) includes Medicare Advantage plan paid records for skilled nursing facility stays. Skilled nursing care is the only level of nursing home care that is covered by the Medicare program.
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The Medicare Durable Medical Equipment (Encounter, Final File) includes Medicare Advantage plans paid records for medical supplies.
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The Medicare Home Health Agency (Encounter, Final File) includes Medicare Advantage (MA) plan paid records for home health agency services.
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The Plan Characteristics file contains Medicare Advantage plan and Prescription Drug Plan information separated into six subfiles.The subfiles are:Plan 'Base' or Benefit package filePremiumCost Sharing TierService AreaSpecial Needs PlansMulti-year crosswalk file
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The Risk Score Files are created from the final CMS risk adjustment model outputs for a payment year. These risk scores are used to adjust CMS payments to Medicare Advantage (Part C) plans to account for differences in relative costs among plan enrollees. At this time, only Payment Year (PY)14 risk score files are available for research use. Please see the Medicare Managed Care Manual, Chapter 7 for a discussion of risk adjustment in the Medicare Advantage program.
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When a Medicare beneficiary with Part D coverage fills a prescription, the prescription drug plan submits a record to CMS. The PDE file includes all transactions covered by the Medicare prescription drug plan for both Prescription Drug Plans (PDPs) and Medicare Advantage Prescription Drug Plans (MA-PDs).
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The Medicare Part D Drug Characteristics file refers to a set of variables that are appended to the Medicare Part D Event file (PDE). Researchers need to request the specific variables required for their study and CMS must approve the release.
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The Medicare Part D Formulary file is a suite of three sub-files: formulary, excluded drug and Over the Counter Drug that contain information on how the plan covers the prescription drugs filled (as described in the Part D Drug Event (PDE) file.
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The Part D Pharmacy Characteristics file provides information about the pharmacy identified as the source of the drug for each Part D Event (PDE) prescription fill record.
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The MD-PPAS file assigns Medicare providers to medical practices based on tax identification numbers and elaborates on the Centers for Medicare & Medicaid Services (CMS) provider specialty classification. This provider-level dataset is built around two identifiers: the national provider identifier (NPI) and the tax identification number (TIN).
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CMS has created a set of analytical files that contain data from the Medicare Shared Saving Program. There are two separate files in this data set:The Shared Savings Program Beneficiary-Level Research Identifiable File (RIF)The Shared Savings Program Provider-Level RIF
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CMS has created a set of analytical files that contain data from the Medicare Shared Saving Program. There are two separate files in this data set:The Shared Savings Program Beneficiary-Level Research Identifiable File (RIF)The Shared Savings Program Provider-Level RIF
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The National Health and Aging Trends Study (NHATS) collects interview data on functioning in late life among the elderly population. NHATS began collecting data in 2011, with over 8,000 Medicare beneficiaries responding to the first round.
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The Standardized Patient Assessment Data Elements (SPADEs) file includes standardized data elements developed by CMS to meet the requirements of the Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014. The IMPACT Act requires the reporting of standardized patient assessment data with regard to quality measures and SPADEs. In addition, the IMPACT Act requires assessment data to be standardized and interoperable to allow for exchange of the data among post-acute providers and other providers..
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What Can Open Rif Files
The Value Modifier (VM) Beneficiary-Level Research Identifiable File (RIF) includes one record for each beneficiary who was attributed to a practice subject to the VM based on the given performance year. Using the RIF data, researchers can examine differences in beneficiary characteristics, costs across practices, and the stability of beneficiaries attributed to a specific practice across time. Program and participation information can be found on the CMS website.
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The Value Modifier (VM) NPI-Practice-Level Research Identifiable File (RIF) includes one record for each eligible professional associated with a practice subject to the VM based on the given performance year. Using the RIF data, researchers can examine practice specialty composition, size, and practice changes across performance years.
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The Value Modifier (VM) Practice-Level Research Identifiable File (RIF) includes one record for each practice that was subject to the VM based on the given performance year. Using the RIF data, researchers can examine trends in cost and quality performance and identify factors supporting higher quality at lower cost.The VM Practice-Level RIF contains Quality and Resource Use Report (QRUR) and VM information. Program and participation information is found on the CMS website.
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The Medicare-Medicaid Linked Enrollee Analytic Data Source (MMLEADS) suite of files includes beneficiary-level Medicare and Medicaid enrollment and claims data for Medicare-only, Medicare-Medicaid dually enrolled and Medicaid-only blind and disabled beneficiaries. The 27 CCW Chronic Conditions plus an additional 25 other conditions flags are part of the included data.
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How To Open Rif Files
The Centers for Medicare and Medicaid Services (CMS) has created a set of files that contain Pioneer Accountable Care Organizations information. There are three separate files in the set:Provider-includes one record for each facility or professional participating providerBeneficiary-each record represents an individual beneficiary who was associated with a Pioneer ACOSettlement-one record for each Pioneer ACO provides information on the post-performance year financial settlement
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