A
A/B MAC Jurisdictions
Medicare's claims processing operations have realized significant operational savings
from the consolidation of state workloads and the efficiencies gained through integrating
Part A and Part B functionality.
The Alignment Initiative
The goal is to more effectively integrate the Medicare and Medicaid programs. Partnering with States, health care providers,
caregivers and beneficiaries, CMS will work to improve quality, reduce costs and improve the dual eligible beneficiary experience.
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B
Basic Stand Alone (BSA) Medicare Public Use Files (PUFs)
Medicare claims data of 2008 5% sample PUF for a variety of Medicare claim types.
The claim types are Inpatient, Durable Medical Equipment (DME) Line Items, Prescription
Drug Events (PDE), Hospice Beneficiary, Carrier Line Items, Home Health Agency (HHA),
Outpatient Procedures and Skilled Nursing Facility (SNF) Beneficiary.
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C
Chronic Conditions
Chartbook, geographic data, and dashboard which examine chronic conditions among beneficiaries in order to provide researchers and policymakers a better understanding of
the burden of chronic conditions among beneficiaries and the implications for our health care system. These reports also highlight the use of health care services by
beneficiaries with multiple chronic conditions and Medicare spending associated with multiple chronic conditions.
CMS Dashboards
Information on Medicare Inpatient Hospital and Medicare Prescription Drug Benefit
Dashboard BETA.
CMS Fast Facts
CMS has developed a new quick reference statistical summary on annual CMS program and financial data. CMS Fast Facts includes summary information on total program enrollment,
utilization, expenditures, as well as total number of Medicare providers including physicians by specialty area.
CMS Fast Facts mobile site
Provides program and financial data all at the touch of your fingertips. Formatted to open on smart phone or tablet.
CMS-2567
Statement of Deficiencies and Plan of Correction for Nursing Homes.
CMS Innovation Center
The Center identifies, develops, supports, and evaluates innovative models of payment and care service delivery for Medicare, Medicaid and CHIP beneficiaries using an open, transparent, and competitive process.
CMS Statistics (blue book)
Reference booklet provides a quick reference for summary information about health expenditures and the Medicare and Medicaid health insurance programs.
Congressional Budget Office
Provides objective analyses on economic and budgetary decisions on the programs
covered by the federal budget for the Congressional budget process.
Cost Reports
These reports reflect data as reported to the Healthcare Cost Report Information
System (HCRIS) by Medicare Fiscal Intermediaries.
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D
Data Navigator
An easy-to-use, menu-driven search tool that makes the data and information resources of the Centers for Medicare and
Medicaid Services (CMS) more easily available. Use the Data Navigator to find data and information products for specific
CMS programs, health care topics or settings-of-care. Navigator displays search results by data type making it easier to
locate specific types of information (e.g., data files, publications, statistical reports, etc.).
Data.gov Catalogs
Public access to machine readable datasets generated by the Executive Branch of
the Federal Government. Use the Data.gov catalog link to easily download and use
CMS datasets.
Data.Medicare.Gov
Used primarily by health policy researchers and the media to access data in an interactive
format.
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E
Electronic Health Records (EHR) Incentive Programs
The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals,
eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful
use of certified EHR technology.
End Stage Renal Disease Prospective Payment System (ESRD PPS)
On January 1, 2011, the CMS implementation for ESRD PPS for outpatient maintenance dialysis began. Posted on the ESRD PPS website are key trends from the first year of monitoring and outcome
information pre-and post-implementation, including morbidity and mortality, anemia management, bone and mineral metabolism, access infection, and fluid management.
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F
Federal Digital System (FDsys)
Replaced GPO Access as the official online repository of government laws, regulations,
court decisions and Congressional deliberations.
Five-Star Quality Rating System
CMS created the Five-Star Quality Rating System to help consumers, their families, and caregivers compare nursing homes more easily and to help identify areas about which you may want to ask questions.
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G
There is no information starting with the letter G.
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H
Health Care Information
System (HCIS)
Contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency
and Hospice) & Medicare Part B (Outpatient) based on the type and state of the
institutional provider.
HealthCare.gov
Designed to help all Americans, not just those covered by Medicare or Medicaid,
get the information they need to make the best choices about their health care (Insurance
Options Finder, Health Finder & consumer rights).
Health Care Innovation Awards
The Health Care Innovation Awards are funding up to $1 billion in grants to applicants who will implement the most compelling new ideas to deliver better health,
improved care and lower costs to people enrolled in Medicare, Medicaid and Children's Health Insurance Program (CHIP), particularly those with the highest health care needs.
Healthdata.gov
This site is dedicated to making high value health data more accessible to entrepreneurs, researchers, and policy makers in the hopes of better health outcomes for all.
A Federal government website managed by the Department of Health & Human Services.
HHS Electronic FOIA Reading Room
Contains HHS material, including final opinions, Departmental Appeals Board decisions,
policy statements, administrative manuals, and frequently requested records.
HHS Information Resources Directory
Browse an alphabetical list of hundreds of HHS resources organized by topic (e.g.,
abuse, aging, civil rights, etc.) and find a link to web sites at HHS with information
on those topics.
HHS Information Resources Guide
Read online information, learn how to request information, and find operating divisions'
and program offices' publications contacts at this Guide to HHS Information Resources
organized by HHS agency.
HHS Open Government
Engage with HHS as it makes its operations more transparent to the public. Collaborate
on data sets, tools and HHS initiatives to help us serve the public more effectively.
Hospital Outpatient PPS
Calendar year files that contain payment amounts and supporting files for services
paid under the OPPS.
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I
ICD-10
Find resources and ICD-10 and Version 5010 Implementation Timelines to help, Payer Resources and Vendor Resources
with the U.S. health care industry's upgrade to Version 5010 and transition to ICD-10.
Identifiable Data Files
Identifiable Data Files contain actual beneficiary-specific and physician-specific
information. Identifiable Files require a formal request to be submitted to CMS
for approval.
Insight Briefs
Intended to provide readers with timely, data driven analysis and insights on the Medicare and Medicaid programs.
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J
There is no information starting with the letter J.
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K
There is no information starting with the letter K.
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L
Limited Data Sets
Files that contain beneficiary level health information but exclude specified direct
identifiers as outlined in the Health Insurance Portability and Accountability Act
(HIPAA Privacy Rule).
Limited Income Resources
Information for those with limited income and resources (those who may qualify for or already have the Low
Income Subsidy to lower their prescription drug coverage costs.
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M
MDS 2.0 Public Reports
Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare or
Medicaid certified nursing homes.
Medicaid Managed Care Enrollment Report
Profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. The managed care enrollment
statistics include enrollees receiving comprehensive benefits and limited benefits and are point-in-time counts.
Medicaid State Waivers and Program
Demonstrations
The Social Security Act authorizes multiple waiver and demonstration authorities
to allow states flexibility in operating Medicaid programs. Access what kinds of
waivers and demonstrations have been proposed and/or approved in your state.
Medicaid Statistical Information System (MSIS) Drug Summary Mart
Provides background needed to take advantage of the capabilities of the MSIS Drug Summary Data mart. This mart allows the user
to develop high level Medicaid utilization statistics for selected groups of drugs covering a range of Medicaid program
statistics using a simple drag-and-drop table building tool.
Medicaid Statistical Information System (MSIS) State Summary Mart
Provides background needed to take advantage of the capabilities of the MSIS State Summary Data mart. This mart allows
the user to develop high-level statistical tables covering a range of Medicaid program statistics using a simple drag-and-drop
table building tool.
Medicare Ambulance Fee Schedule
Provides calendar year files that contain the payment amounts used to pay for services
provided by ambulance providers and suppliers.
Medicare & Medicaid Research Review (MMRR)
An authoritative medium for disseminating high-quality and relevant research to a wide audience of Medicare, Medicaid, and Children's Health
Insurance stakeholders. MMRR is a peer-reviewed, online journal (ISSN 2159-0354) reporting data and research that informs current and future
directions of CMS programs. The journal seeks to examine and evaluate health care coverage, quality and access to care for beneficiaries, and
payment for health services.
Medicare & Medicaid Statistical Supplement
An annual report that provides detailed statistical information on Medicare, Medicaid, and CMS programs. The Supplement includes 115 tables and 67
charts describing health expenditures for the entire U.S. population, characteristics of the Medicare and Medicaid covered populations,
use of services, and expenditures under these programs. This CMS report is published annually in electronic form and is available for each
year from 2001 through present.
Medicare Claims Synthetic Public Use Files (SynPUFs)
Created to allow interested parties to gain familiarity using Medicare claims data while protecting beneficiary privacy. The data structure
of the Medicare SynPUFs is very similar to the CMS Limited Data Sets, but with a smaller number of variables. They provide data analysts
and software developers the opportunity to develop programs and products utilizing the identical formats and variable names as those
which appear in the actual CMS data files.
Medicare Clinical Lab Fee Schedule
Provides calendar year files that contain the payment amounts used to pay for lab
services paid under the Medicare Clinical Lab Fee Schedule.
Medicare Contracting Reform
CMS will ensure that Medicare claims continue to be processed effectively, accurately
and in a timely manner and contracts will be subject to the Federal Acquisition
Regulation.
Medicare Coverage
Database
Contains all National Coverage Determinations (NCDs) and Local Coverage Determinations
(LCDs), local articles, and proposed NCD decisions. The database also includes National
Coverage policy related documents, including National Coverage Analyses (NCAs),
Coding Analyses for Labs (CALs), Medicare Evidence Development & Coverage Advisory
Committee (MEDCAC) proceedings, and Medicare coverage guidance documents.
Medicare Current Beneficiary Survey (MCBS)
A continuous, multipurpose survey of a nationally representative sample of the Medicare population, conducted by the Office of
Information Products and Data Analysis (OIPDA) of the Centers for Medicare & Medicaid Services (CMS) through a contract with
Westat. The central goals of MCBS are to determine expenditures and sources of payment for all services used by Medicare
beneficiaries, including co-payments, deductibles, and non-covered services; to ascertain all types of health insurance
coverage and relate coverage to sources of payment; and to trace processes over time, such as changes in health status and
spending down to Medicaid eligibility and the impacts of program changes, satisfaction with care, and usual source of care.
Medicare Geographic Variation
Federal policymakers and health researchers have long recognized that the amount and quality of the health care services that Medicare beneficiaries receive vary
substantially across different regions of the United States. The Office of Information Products and Data Analytics (OIPDA) at CMS has
made several resources available to researchers, policymakers, and other users who are interested in learning more about geographic variation
in Medicare.
Medicare Managed Care Appeals & Grievances
Medicare health plans, which include Medicare Advantage (MA) plans – such as Health Maintenance Organizations, Preferred
Provider Organizations, Medical Savings Account plans and Private Fee-For-Service plans – Cost Plans and Health Care
Prepayment Plans, must meet the requirements for grievance and appeals processing under Subpart M of the Medicare
Advantage regulations.
Medicare Ombudsman
Working to ensure people with Medicare get the information and help they need to
understand their Medicare options, and to apply their rights and protections.
Medicare Part B Drugs
Quarterly files contain the payment amounts used to pay for Medicare Part B covered
drugs.
Medicare Plan Finder
Compare options for joining health and drug plans under the Medicare program, including
Medicare Advantage and Medicare Prescription Drug plans.
Medicare Provider Charge Data
As part of the Obama administration's work to make our health care system more affordable and accountable, data are being released
that show significant variation across the country and within communities in what providers charge for common services. These data include
information comparing the charges for the 100 most common inpatient services and 30 common outpatient services. Providers determine what they will
charge for items and services provided to patients and these charges are the amount the providers bill for an item or service.
Medicare Shared Savings Program
Facilitates coordination and cooperation among providers to improve the quality
of care for Medicare fee-for-service beneficiaries and reduce unnecessary costs.
Medicare Supplier Directory
Provides names, addresses and contact information for suppliers that provide services or products under the Medicare program.
MyMedicare.gov
For specific questions about your claims, records, or expenses, visit, or call 1-800-MEDICARE.
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N
Nursing Home Compare
Find nursing homes in your area. This tool has detailed information about every
Medicare and Medicaid-certified nursing home in the country.
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O
Office for Civil Rights (OCR) - How To File a Complaint
If you believe that you have been discriminated against because of your race, color, national origin, disability,
age, sex or religion by a health care or human services provider (such as a hospital, nursing home, social service
agency) or by a State or local government health or human services agency, you may file a complaint with the Office
for Civil Rights (OCR).
Outcome and Assessment Information Set (OASIS) – C Reports
Medicare-certified home health agencies are required to use a standard set of data items, known as OASIS (Outcome and Assessment
Information Set) as part of a comprehensive assessment for all patients who are receiving skilled care that is reimbursed by
Medicare or Medicaid.
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P
Personal Computer (PC) Pricer
Tool used to estimate Medicare Prospective Payment System (PPS) payments for ESRD,
Inpatient Hospital, SNF, Home Health, IRF, IPF, LTCH, and Outpatient.
Physician Fee Schedule (PFS)
Includes PFS National Payment files, Physician Fee Schedule Relative Value Unit
(RVU) files and PFS Carrier Specific files.
Pioneer ACO Model
Designed for health care organizations and providers that are already experienced in coordinating care for patients across care settings.
Physician Self Referral
Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law and
commonly referred to as the "Stark Law".
PQRS and eRx Experience Report
The PQRS and eRx Experience report summarizes the reporting experience of eligible professionals in these programs for a given program year including,
historical trends, and preliminary results for the current program year.
Provider Compliance Group Interactive Map
The U.S. Resource Map allows you to access state-specific: Organizations that provide services in your state, Contact information of various organizations,
E-mails and websites to the different organizations within the state selected, Information on other US territories.
Provider Reimbursement Review Board (PRRB) Decisions
The PRRB is an independent panel to which a Medicare provider of services may appeal
if it is dissatisfied with a final determination of its fiscal intermediary or the
Centers for Medicaid & Medicare Services (CMS).
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Q
Qualified Entity Program
Section 10332 of the Affordable Care Act amends section 1874 of the Social Security Act (the Act) by adding a new subsection (e)
requiring standardized extracts of Medicare claims data under parts A, B, and D to be made available to ''qualified entities'' for
the evaluation of the performance of providers and suppliers. Qualified entities may use the information obtained under section 1874(e)
of the Act for the purpose of evaluating the performance of providers and suppliers, and to generate public reports regarding such performance.
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R
Recovery Audit Program –Recent
Updates
Quarterly Recovery Audit Activity including Demanded and Corrected Amounts by Contractor,
Number of Additional Documentation Requests and Top Issues and Problems identified
by CMS.
Research Data Assistance Center (ResDAC)
Provides free assistance to academic and non-profit researchers interested in using Medicare, Medicaid, SCHIP, and MCBS data for research. ResDAC offers a number of services
for researchers with all levels of experience using or planning to use CMS data. Services include technical data assistance, information on available data resources, and training.
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S
Shared Savings Program
Facilitates coordination and cooperation among providers to improve the quality
of care for Medicare fee-for-service beneficiaries and reduce unnecessary costs.
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T
There is no information starting with the letter T.
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U
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V
There is no information starting with the letter V.
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W
There is no information starting with the letter W.
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X
There is no information starting with the letter X.
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Y
There is no information starting with the letter Y.
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Z
There is no information starting with the letter Z.
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