National Summary of Inpatient Charge Data by Medicare Severity Diagnosis Related Group (MS-DRG), FY2013data.cms.gov | Last Updated 2017-10-31T15:05:15.000Z
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 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) 2013.
- API data.cms.gov | Last Updated 2019-04-26T19:21:16.000Z
The ITU database is a listing of Indian Health Service, tribally operated, or urban Indian health programs (ITUs) that offer any type of long-term services and supports (LTSS)—a variety of services for elders and people with disabilities. This dataset includes 400+ organizations in Indian Country that provide LTSS care. This includes a vast array of clinics and facilities, including urban Indian health organizations, nursing homes, senior centers, adult day programs, nutrition programs, hospice, social service and program offices, and more. Of the organizations, 260+ are Title VI grantees.
- API data.cms.gov | Last Updated 2017-06-22T15:27:53.000Z
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.
- API data.cms.gov | Last Updated 2018-11-14T16:34:10.000Z
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.
- API data.cms.gov | Last Updated 2016-08-28T21:04:32.000Z
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.
- API data.cms.gov | Last Updated 2018-10-10T19:32:00.000Z
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.
- API data.cms.gov | Last Updated 2019-02-15T14:34:53.000Z
CPT copyright 2014 American Medical Association. All Rights Reserved. The Outpatient Hospital Utilization and Payment Public Use File (Outpatient Hospital PUF) presents information on comprehensive APC (C-APC) services provided to Medicare fee-for-service beneficiaries. The Outpatient Hospital PUF presents information on the number of APC services, hospitals' average total estimated submitted charges, the average Medicare allowed charges (which includes Medicare regular provider payments and beneficiary cost-sharing payments), the average Medicare regular provider payments, the number of APC services with outlier payments, and the average Medicare outlier provider payments among those services for 25 C-APC Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for calendar year (CY) 2015. The estimated average charges and the average Medicare payments are provided at the individual hospital level. The actual charges at an individual hospital for an individual service within these APC groups may differ.
Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) Provider-Level Measure Rates for Four Conditionsdata.cms.gov | Last Updated 2018-05-08T15:43:02.000Z
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, 2011 through June 30, 2013. 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.
- API data.cms.gov | Last Updated 2018-02-06T20:03:27.000Z
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 2013 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.
- API data.cms.gov | Last Updated 2019-05-01T16:43:25.000Z
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)