Medicare data are useful for understanding the cost and use of healthcare, but they are also very complex. Understanding the origin, structure and contents of the data is essential to designing a successful research project.
Full Answer
What is Medicare data used for in research?
Medicare data are useful for understanding the cost and use of healthcare, but they are also very complex. Understanding the origin, structure and contents of the data is essential to designing a successful research project.
How do I obtain Medicare and/or Medicaid data for research?
The ResDAC website provides all of the necessary information on how to obtain Medicare and/or Medicaid data for researchers, including requests for both restricted and limited datasets as well as public use files (PUF)/non-identifiable files. CMS data are used to complete the specific aims of an NIA grant.
Can Medicare Administrative data answer your research question?
You believe that Medicare administrative data may answer your research question, and you want to understand the strengths and limitations of the data. Previous participants have found the workshop more useful after they have some experience with the data, although experience is not required for attendance.
Will Medicare pay for clinical research studies?
If you join certain covered clinical research studies, Medicare will pay for your covered services as if you were in Original Medicare. This means that your Medicare health plan can’t keep you from joining a clinical research study. However, you should tell your plan before you start a study. 6
What is the research agenda for Medicare?
Does Medicare Advantage have a higher value?
About this website
How do I get Medicare data for research?
The ResDAC website provides all of the necessary information on how to obtain Medicare and/or Medicaid data for researchers, including requests for both restricted and limited datasets as well as public use files (PUF)/non-identifiable files. CMS data are used to complete the specific aims of an NIA grant.
Are Medicare claims public data?
CMS is committed to increasing access to its Medicare claims data through the release of de-identified data files available for public use. These files are available to researchers as free downloads in CSV format. They contain non-identifiable claim-specific information and are within the public domain.
Does Medicare send surveys?
What is it? The Medicare Current Beneficiary Survey (MCBS) is a survey of people with Medicare. We use it to learn more about things like how people get their health care, the rising cost of health care, and how satisfied people are with their care.
What kind of data does CMS collect?
The data held currently by CMS come from a variety of sources, of which the most important is claims for all types of services provided. All claims contain basic diagnostic information, as well as information on date of service, the type of service provided, and the identity of the prescribing physician.
What is Medicare data?
Medicare administrative data or Medicare Fee-for-Service claims (administrative) data, also known as health services utilization data, are collected by the Centers for Medicare and Medicaid Services (CMS) and derived from reimbursement information or the payment of bills.
What is healthcare claims data?
Claims data, also known as administrative data, are another sort of electronic record, but on a much bigger scale. Claims databases collect information on millions of doctors' appointments, bills, insurance information, and other patient-provider communications.
What is the purpose of the Medicare questionnaire?
Providers may use this as a guide to help identify other payers that may be primary to Medicare. This questionnaire is a model of the type of questions that may be asked to help identify Medicare Secondary Payer (MSP) situations.
What is the Medicare experience survey?
About the Medicare CAHPS Survey Medicare CAHPS is designed to measure the Medicare member's experience and satisfaction with their Medicare Advantage and Prescription Drug Plan based on the quality of care and services received in the past 6 months.
Is CMS survey legitimate?
This survey is authorized by section 1875 (42 USC 139511) of the Social Security Act and is conducted by NORC for the U.S. Department of Health and Human Services. The OMB Number for this survey is 0938-0568 and expires 02/29/2024.
What is the CMS database?
The CMS system database is used to store BI platform information, such as user, server, folder, document, configuration, and authentication details. It is maintained by the Central Management Server (CMS), and in other documentation may be referred to as the system database or repository.
What is administrative claims data?
Administrative claims data includes information necessary for reimbursement of medical services, which generally consists of diagnoses and procedures received during inpatient, outpatient, or emergency room visits, and dispensed prescription medications.
What does the CMS regulate?
The CMS oversees programs including Medicare, Medicaid, the Children's Health Insurance Program (CHIP), and the state and federal health insurance marketplaces. CMS collects and analyzes data, produces research reports, and works to eliminate instances of fraud and abuse within the healthcare system.
What is the research agenda for Medicare?
The research agenda has three main areas: 1) innovative and comprehensive analyses of current initiatives, 2) rigorous research on the current form of integration, and 3) research on innovative beneficiary as well as provider payment policy. Such research will help ensure Medicare’s financial viability and long-term value.
Does Medicare Advantage have a higher value?
The previous P01 research compared Medicare Advantage to traditional Medicare and determined that on average, Medicare Advantage plans appear to offer higher value in contrast to its previous performance, but that policy changes would be needed in order to move beneficiaries to the plan and make it more effective.
How do clinical studies work?
Clinical research studies (also called clinical trials) test how well different types of medical care work and if they’re safe, like how well a cancer drug works. Clinical research studies may involve diagnostic tests, surgical treatments, medicine, or new types of patient care. They may: 1 Study how well new treatments and tests benefit patients 2 Compare different treatments for the same condition to see which treatment is better 3 Study new ways to use existing treatments
What is Medicare approved amount?
Medicare-Approved Amount. In Original Medicare, this is the amount a doctor or supplier that accepts assignment can be paid. It may be less than the actual amount a doctor or supplier charges. Medicare pays part of this amount and you’re responsible for the difference. , depending on the treatment you get.
Overview
Data.Medicare.gov lists official data used on the Medicare.gov Compare websites and directories. We want to make this data available in open, accessible, and machine-readable formats.
Getting started
Visit Data.Medicare.gov to see all datasets that are available and ready to use.
Research
Data and Statistical Resources on Dually Eligible Medicare-Medicaid Beneficiari…
Statistics, Trends & Reports
Prescription Drug Plan Formulary, Pharmacy Network, and Pricing Information Fil…
What is CMS data?
The Centers for Medicare and Medicaid Services (CMS) has a contract with the Research Data Assistance Center (ResDAC) to facilitate data access requests . The ResDAC website provides all of the necessary information on how to obtain Medicare and/or Medicaid data for researchers, including requests for both restricted and limited datasets as well as public use files (PUF)/non-identifiable files. CMS data are used to complete the specific aims of an NIA grant.
What is a DUA for Medicare?
A DUA is an agreement for use of CMS data containing individual identifiers. The form outlines in detail the confidentiality requirements of the Privacy Act ...
Does the NIA approve CMS?
It is important to note that the NIA does not grant approval on behalf of CMS; CMS does that directly. Once the NIA reviews the documents provided, we will contact you with an approval (or, a follow-up if materials sent are insufficient). At that point, you may send your approved request (s) to ResDAC and CMS.
What is the research agenda for Medicare?
The research agenda has three main areas: 1) innovative and comprehensive analyses of current initiatives, 2) rigorous research on the current form of integration, and 3) research on innovative beneficiary as well as provider payment policy. Such research will help ensure Medicare’s financial viability and long-term value.
Does Medicare Advantage have a higher value?
The previous P01 research compared Medicare Advantage to traditional Medicare and determined that on average, Medicare Advantage plans appear to offer higher value in contrast to its previous performance, but that policy changes would be needed in order to move beneficiaries to the plan and make it more effective.