The CMS Program Statistics - Medicare Part D tables provide use and Part D drug costs by type of Part D plan (stand-alone prescription drug plan and Medicare Advantage prescription drug plan). For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data. Below is the list of tables: MDCR UTLZN D 1. Medicare Part D Utilization: Average Annual Prescription Drug Fills by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Generic Dispensing Rate, Yearly Trend MDCR UTLZN D 2. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 3. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 4. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan and Demographic Characteristics MDCR UTLZN D 5. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan and Demographic Characteristics MDCR UTLZN D 6. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan, by Area of Residence MDCR UTLZN D 7. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan, by Area of Residence MDCR UTLZN D 8. Medicare Part D Utilization: Number of Part D Utilizers and Average Annual Prescription Drug Fills by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 9. Medicare Part D Utilization: Number of Part D Utilizers and Drug Costs by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 10. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Events (Fills) and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Demographic Characteristics MDCR UTLZN D 11. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Area of Residence

This data package contains health indicator information about the total Medicare costs for Medicare fee-for-service beneficiaries and Locality County Crosswalk for 2017 and 2018. It also shows the Physician Fee Schedule National Payment amount and relative value units.

This data package contains the data package includes all datasets released by the Centers for Medicare and Medicaid Services (CMS) that belong to the category of Ratebooks & Supporting Data for Medicare Advantage Plan costs estimation. The data contained are related to the two components of the capitated payment (rates and risk scores) and to the county and regional statutory benchmark.

The Medicare Fee-for-Service (FFS) Comprehensive Error Rate Testing (CERT) dataset provides information on a random sample of FFS claims to determine if they were paid properly under Medicare coverage, coding, and payment rules. The dataset contains information on type of FFS claim, Diagnosis Related Group (DRG) and Healthcare Common Procedure Coding System (HCPCS) codes, provider type, type of bill, review decision, and error code. Please note, each reporting year (RY) contains claims submitted July 1 two years before the report through June 30 one year before the report. For example, the 2024 data contains claims submitted July 1, 2022 through June 30, 2023.

The Medicare Fee-For-Service Public Provider Enrollment dataset includes information on providers who are actively approved to bill Medicare or have completed the 855O at the time the data was pulled from the Provider Enrollment, Chain, and Ownership System (PECOS). The release of this provider enrollment data is not related to other provider information releases such as Physician Compare or Data Transparency. Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

This data package includes datasets that provide the necessary data to evaluate the Medicare Advantage system of fee-for-service payments to hospitals and practices based on the geographical location. The datasets contain data about the adjustments indices used by Centers for Medicare and Medicaid Services (CMS) at county and state level and about the repriced reimbursements based on indices, at county and state level for aged, disabled and beneficiaries with End-Stage Renal Disease (ESRD).

This data package contains claims-based data about beneficiaries of Medicare program services including Inpatient, Outpatient, related to Chronic Conditions, Skilled Nursing Facility, Home Health Agency, Hospice, Carrier, Durable Medical Equipment (DME) and data related to Prescription Drug Events. It is necessary to mention that the values are estimated and counted, by using a random sample of fee-for-service Medicare claims.

Content

The hospital readmission rate PUF presents nation-wide information about inpatient hospital stays that occurred within 30 days of a previous inpatient hospital stay (readmissions) for Medicare fee-for-service beneficiaries. The readmission rate equals the number of inpatient hospital stays classified as readmissions divided by the number of index stays for a given month. Index stays include all inpatient hospital stays except those where the primary diagnosis was cancer treatment or rehabilitation. Readmissions include stays where a beneficiary was admitted as an inpatient within 30 days of the discharge date following a previous index stay, except cases where a stay is considered always planned or potentially planned. Planned readmissions include admissions for organ transplant surgery, maintenance chemotherapy/immunotherapy, and rehabilitation.

This dataset has several limitations. Readmissions rates are unadjusted for age, health status or other factors. In addition, this dataset reports data for some months where claims are not yet final. Data published for the most recent six months is preliminary and subject to change. Final data will be published as they become available, although the difference between preliminary and final readmission rates for a given month is likely to be less than 0.1 percentage point.

Data Source: The primary data source for these data is the CMS Chronic Condition Data Warehouse (CCW), a database with 100% of Medicare enrollment and fee-for-service claims data. For complete information regarding data in the CCW, visit http://ccwdata.org/index.php. Study Population: Medicare fee-for-service beneficiaries with inpatient hospital stays.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

Cover photo by Justyn Warner on Unsplash
Unsplash Images are distributed under a unique Unsplash License.

This dataset is distributed under NA

The Medicare Physician & Other Practitioners by Provider dataset provides information on use, payments, submitted charges and beneficiary demographic and health characteristics organized by National Provider Identifier (NPI). Note: This full dataset contains more records than most spreadsheet programs can handle, which will result in an incomplete load of data. Use of a database or statistical software is required.

The tables below display new National Average Drug Acquisition Cost (NADAC) rates, sorted by Drug Product and Date. The drug products listed have not had a NADAC rate in the past.

The Medicare Clinical Laboratory Fee Schedule (CLFS) dataset provides raw data reported by any applicable laboratories that reported a volume greater than 10 tests for the data collection period. As described by the Protecting Access to Medicare Act, Applicable Laboratories must report to CMS private payor rates and associated volumes for laboratory tests on the Clinical Laboratory Fee Schedule.

This statistic displays the Centre for Medicare and Medicaid Services' (CMS) estimates of total penalties on Medicare hospitals with high readmission rates in the U.S. from 2013 to 2017, in million U.S. dollars. In financial year 2013, CMS estimated about *** million U.S. dollars of total penalties whereas in FY 2017 penalties are estimated to increase to *** million U.S. dollars.

Content

Clinical Laboratory Fee Schedule (CLFS) Applicable Information Raw Data File-This file excludes HCPCS codes for which 10 or fewer reporting entities (TINs) submitted data.

Context

This is a dataset hosted by the Centers for Medicare & Medicaid Services (CMS). The organization has an open data platform found here and they update their information according the amount of data that is brought in. Explore CMS's Data using Kaggle and all of the data sources available through the CMS organization page!

• Update Frequency: This dataset is updated daily.

Acknowledgements

This dataset is maintained using Socrata's API and Kaggle's API. Socrata has assisted countless organizations with hosting their open data and has been an integral part of the process of bringing more data to the public.

Cover photo by Martha Dominguez de Gouveia on Unsplash
Unsplash Images are distributed under a unique Unsplash License.

This dataset is distributed under NA

Methodology

None

Usage

This dataset page includes some of the tables from the Medicare Data in PHS's possession. Other Medicare tables are included on other dataset pages on the PHS Data Portal. Depending upon your research question and your DUA with CMS, you may only need tables from a subset of the Medicare dataset pages, or you may need tables from all of them.

The location of each of the Medicare tables (i.e. a chart of which tables are included in each Medicare dataset page) is shown here.

Before Manuscript Submission

All manuscripts (and other items you'd like to publish) must be submitted to

support@stanfordphs.freshdesk.com for approval prior to journal submission.

We will check your cell sizes and citations.

For more information about how to cite PHS and PHS datasets, please visit:

https:/phsdocs.developerhub.io/need-help/citing-phs-data-core

Documentation

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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Section 2

Metadata access is required to view this section.

The Medicare COVID-19 Hospitalization Trends dataset contains aggregate information from Medicare Fee-for-Service claims, Medicare Advantage encounter, and Medicare enrollment data. It provides insight around the groups of beneficiaries that were hospitalized at different points during the pandemic. CMS publicly released the first Preliminary Medicare COVID-19 Snapshot in June 2020 during the early stages of the Public Health Emergency for COVID-19. That report focused on COVID-19 cases and hospitalizations data for Medicare beneficiaries with a COVID-19 diagnosis. Throughout 2020 and 2021, that report was subsequently updated with refreshed data 13 times. Beginning in October 2021, CMS shifted its public COVID-19 reporting away from cumulative case and hospitalization rates to hospitalization trends over time with the release of this report, the Medicare COVID-19 Hospitalization Trends Report. All prior releases of both the Preliminary Medicare COVID-19 Snapshot and the Medicare COVID-19 Hospitalization Trends Report are available for download in the Medicare COVID-19 Data - Prior Releases file.

The Centers for Medicare and Medicaid Services CMS is dedicated to continually strengthening and improving the Medicare program, which provides vital services to millions of Americans. CMS uses data from the Comprehensive Error Rate Testing CERT program and other sources of information to address improper payments in the Medicare FFS program through various corrective actions. Each year, the Department of Health and Human Services Agency Financial Report outlines actions the agency will implement to prevent and reduce improper payments. CMS and the Medicare Administrative Contractors MACs aim to help improve provider compliance with Medicare FFS policies and requirements. Provider compliance is fundamental to reducing improper payment rates. The maps displays the 2014 and 2015 improper payment rate information for the Medicare FFS program for A-B, Home Health-Hospice, and Durable Medical Equipment DME MAC jurisdictions. The jurisdictions listed are based on the MAC jurisdictions assigned during the 2014 and 2015 Medicare FFS improper payment report periods i.e., July 1, 2012 - June 30, 2013, and July 1, 2013 - June 30, 2014, respectively. An Error Rate Contribution Score was assigned to each jurisdiction to reflect two key variables, the jurisdictions improper payment rate and share of national improper payments.

The Health Insurance Marketplace Public Use Files contain data on health and dental plans offered to individuals and small businesses through the US Health Insurance Marketplace.

Exploration Ideas

To help get you started, here are some data exploration ideas:

• How do plan rates and benefits vary across states?
• How do plan benefits relate to plan rates?
• How do plan rates vary by age?
• How do plans vary across insurance network providers?

See this forum thread for more ideas, and post there if you want to add your own ideas or answer some of the open questions!

Data Description

This data was originally prepared and released by the Centers for Medicare & Medicaid Services (CMS). Please read the CMS Disclaimer-User Agreement before using this data.

Here, we've processed the data to facilitate analytics. This processed version has three components:

1. Original versions of the data

The original versions of the 2014, 2015, 2016 data are available in the "raw" directory of the download and "../input/raw" on Kaggle Scripts. Search for "dictionaries" on this page to find the data dictionaries describing the individual raw files.

2. Combined CSV files that contain

In the top level directory of the download ("../input" on Kaggle Scripts), there are six CSV files that contain the combined at across all years:

• BenefitsCostSharing.csv
• BusinessRules.csv
• Network.csv
• PlanAttributes.csv
• Rate.csv
• ServiceArea.csv

Additionally, there are two CSV files that facilitate joining data across years:

• Crosswalk2015.csv - joining 2014 and 2015 data
• Crosswalk2016.csv - joining 2015 and 2016 data

3. SQLite database

The "database.sqlite" file contains tables corresponding to each of the processed CSV files.

The code to create the processed version of this data is available on GitHub.

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. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program available from the CMS Chronic Condition Data Warehouse (www.ccwdata.org). The data in the Physician and Other Supplier PUF covers calendar year 2014 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

The Medicare Part D Opioid Prescribing Rates by Geography dataset provides information on geographic comparisons of the number and percentage of Medicare Part D opioid prescriptions at the state, county, and ZIP code levels.

The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator 11 (PSI-11) Measure Rates dataset provides information on provider-level measure rates regarding one preventable complication (postoperative respiratory failure) for Medicare fee-for-service discharges. The PSI-11 measure data is solely reported for providers’ information and quality improvement purposes and are not a part of the Deficit Reduction Act (DRA) Hospital-Acquired Condition (HAC) Payment Provision or HAC Reduction Program.