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Provider of Services File - OTHER - December 2013
data.cms.gov | Last Updated 2017-06-22T15:33:39.000ZThe 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.
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Medicare Resource Utilization Group (RUG) by State Aggregate Table, CY 2016
data.cms.gov | Last Updated 2019-05-02T13:05:17.000ZThe 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 2016 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.
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Part D Prescriber State Summary Report, Calendar Year 2015
data.cms.gov | Last Updated 2018-11-14T16:26:56.000ZThe Part D Prescriber State 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.
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Provider of Services File - OTHER - June 2014
data.cms.gov | Last Updated 2017-03-29T23:34:08.000ZThe 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.
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Provider of Services File - OTHER - December 2015
data.cms.gov | Last Updated 2017-06-22T15:28:27.000ZThe 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.
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State Innovation Model Initiative: All Awardees
data.cms.gov | Last Updated 2019-10-04T17:42:08.000Z[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.
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CPC Initiative: Participating Primary Care Practices
data.cms.gov | Last Updated 2016-08-28T21:04:14.000ZThe 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.
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Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) Provider-Level Measure Rates for Four Conditions - 2016
data.cms.gov | Last Updated 2017-03-30T00:58:44.000ZThis 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, 2013 through June 30, 2015. The DRA HAC measures, along with the AHRQ PSI-11 – postoperative respiratory failure measure, are solely reported for hospitals’ information and quality improvement purposes, and are not a part of the DRA HAC payment provision or 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 and PSI-11 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.
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Outpatient Prospective Payment System (OPPS) Provider Summary for 30 Selected Ambulatory Payment Classification (APC) Groups - CY2013
data.cms.gov | Last Updated 2017-08-30T17:56:10.000ZA 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.
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2012 Physician/Supplier Procedure Summary
data.cms.gov | Last Updated 2018-07-19T17:26:39.000ZThe 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.