2016–2021. CMS compiles claims data for Medicare and Medicaid patients across a variety of categories and years. This includes Inpatient and Outpatient claims, Master Beneficiary Summary Files, and many other files. Indicators from this data source have been computed by personnel in CDC's Division for Heart Disease and Stroke Prevention (DHDSP). This was one of the datasets provided by the National Cardiovascular Disease Surveillance System and presented on DHDSP’s Data, Trends, and Maps online tool. This tool was retired in April of 2024 and this dataset will not be updated. Contact dhdsprequests@cdc.gov if you need assistance with data previously included in this dataset. The data are organized by location (national and state) and indicator. The data can be plotted as trends and stratified by sex and race/ethnicity.

The Medicare Home Health Agency tables provide use and payment data for home health agencies. The tables include use and expenditure data from home health Part A (Hospital Insurance) and Part B (Medical Insurance) claims.

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 HHA 1. Medicare Home Health Agencies: Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR HHA 2. Medicare Home Health Agencies: Utilization and Program Payments for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR HHA 3. Medicare Home Health Agencies: Utilization and Program Payments for Original Medicare Beneficiaries, by Area of Residence MDCR HHA 4. Medicare Home Health Agencies: Persons with Utilization and Total Service Visits for Original Medicare Beneficiaries, Type of Agency and Type of Service Visit MDCR HHA 5. Medicare Home Health Agencies: Persons with Utilization and Total Service Visits for Original Medicare Beneficiaries, by Type of Control and Type of Service Visit MDCR HHA 6. Medicare Home Health Agencies: Persons with Utilization, Total Service Visits, and Program Payments for Original Medicare Beneficiaries, by Number of Service Visits and Number of Episodes

This is a peer-reviewed supplementary table for the article 'Healthcare resource utilization, costs and treatment associated with myasthenia gravis exacerbations among patients with myasthenia gravis in the USA: a retrospective analysis of claims data' published in the Journal of Comparative Effectiveness Research.Supplementary Table 1: MG treatment definitionsAim: There are limited data on the clinical and economic burden of exacerbations in patients with myasthenia gravis (MG). We assessed patient clinical characteristics, treatments and healthcare resource utilization (HCRU) associated with MG exacerbation. Patients & methods: This was a retrospective analysis of adult patients with MG identified by commercial, Medicare or Medicaid insurance claims from the IBM MarketScan database. Eligible patients had two or more MG diagnosis codes, without evidence of exacerbation or crisis in the baseline period (12 months prior to index [first eligible MG diagnosis]). Clinical characteristics were evaluated at baseline and 12 weeks before each exacerbation. Number of exacerbations, MG treatments and HCRU costs associated with exacerbation were described during a 2-year follow-up period. Results: Among 9352 prevalent MG patients, 34.4% (n = 3218) experienced ≥1 exacerbation after index: commercial, 53.0% (n = 1706); Medicare, 39.4% (n = 1269); and Medicaid, 7.6% (n = 243). During follow-up, the mean (standard deviation) number of exacerbations per commercial and Medicare patient was 3.7 (7.0) and 2.7 (4.1), respectively. At least two exacerbations were experienced by approximately half of commercial and Medicare patients with ≥1 exacerbation. Mean total MGrelated healthcare costs per exacerbation ranged from $26,078 to $51,120, and from $19,903 to $49,967 for commercial and Medicare patients, respectively. AChEI use decreased in patients with multiple exacerbations, while intravenous immunoglobulin use increased with multiple exacerbations. Conclusion: Despite utilization of current treatments for MG,MG exacerbations are associated with a high clinical and economic burden in both commercial and Medicare patients. Additional treatment options and improved disease management may help to reduce exacerbations and disease burden.

Information on utilization and payment data for Home health agency, Hospice, skilled nursing facitlity. Information on Inpatient Prospective Payment System (IPPS) payments, Inpatient Rehabilitation Facilities (IRFs)

DE-SynPUF is provided here as a 1,000 person (1k), 100,000 person (100k), and 2,300,000 persom (2.3m) data sets in the OMOP Common Data Model format. The DE-SynPUF was created with the goal of providing a realistic set of claims data in the public domain while providing the very highest degree of protection to the Medicare beneficiaries’ protected health information. The purposes of the DE-SynPUF are to:

1. allow data entrepreneurs to develop and create software and applications that may eventually be applied to actual CMS claims data;
2. train researchers on the use and complexity of conducting analyses with CMS claims data prior to initiating the process to obtain access to actual CMS data; and,
3. support safe data mining innovations that may reveal unanticipated knowledge gains while preserving beneficiary privacy. The files have been designed so that programs and procedures created on the DE-SynPUF will function on CMS Limited Data Sets. The data structure of the Medicare DE-SynPUF is very similar to the CMS Limited Data Sets, but with a smaller number of variables. The DE-SynPUF also provides a robust set of metadata on the CMS claims data that have not been previously available in the public domain. Although the DE-SynPUF has very limited inferential research value to draw conclusions about Medicare beneficiaries due to the synthetic processes used to create the file, the Medicare DE-SynPUF does increase access to a realistic Medicare claims data file in a timely and less expensive manner to spur the innovation necessary to achieve the goals of better care for beneficiaries and improve the health of the population.

The CMS Program Statistics - Medicare Part A & Part B - All Types of Service tables provide use and payment data by type of coverage and type of service. 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 SUMMARY AB 1. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for All Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 2. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Aged Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 3. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Disabled Original Medicare Beneficiaries by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 4. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage, Demographic Characteristics, and Medicare-Medicaid Enrollment Status MDCR SUMMARY AB 5. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage and by Area of Residence MDCR SUMMARY AB 6. Medicare Part A and Part B Summary: Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Entitlement, Amount of Program Payments, Type of Coverage, and Type of Service

This dataset contains a list of the quality measures displayed on Nursing Home Compare, that are based on Medicare claims data. Each row contains a specific quality measure for a specific nursing home and includes the risk-adjusted score.

Information on Open Payments managed by the Centers for Medicare & Medicaid Services (CMS), which is a national disclosure program created by the Affordable Care Act (ACA) that promotes transparency and accountability by helping consumers understand the financial relationships between pharmaceutical and medical device industries and physicians and teaching hospitals.

The MarketScan health claims database is a compilation of nearly 110 million patient records with information from more than 100 private insurance carriers and large self-insuring companies. Public forms of insurance (i.e., Medicare and Medicaid) are not included, nor are small (< 100 employees) or medium (1000 employees). We excluded the relatively few (n=6735) individuals over 65 years of age because Medicare is the primary insurance of U.S. adults over 65. The EQI was constructed for 2000-2005 for all US counties and is composed of five domains (air, water, built, land, and sociodemographic), each composed of variables to represent the environmental quality of that domain. Domain-specific EQIs were developed using principal components analysis (PCA) to reduce these variables within each domain while the overall EQI was constructed from a second PCA from these individual domains (L. C. Messer et al., 2014). To account for differences in environment across rural and urban counties, the overall and domain-specific EQIs were stratified by rural urban continuum codes (RUCCs) (U.S. Department of Agriculture, 2015). This dataset is not publicly accessible because: EPA cannot release personally identifiable information regarding living individuals, according to the Privacy Act and the Freedom of Information Act (FOIA). This dataset contains information about human research subjects. Because there is potential to identify individual participants and disclose personal information, either alone or in combination with other datasets, individual level data are not appropriate to post for public access. Restricted access may be granted to authorized persons by contacting the party listed. It can be accessed through the following means: Human health data are not available publicly. EQI data are available at: https://edg.epa.gov/data/Public/ORD/NHEERL/EQI. Format: Data are stored as csv files. This dataset is associated with the following publication: Gray, C., D. Lobdell, K. Rappazzo, Y. Jian, J. Jagai, L. Messer, A. Patel, S. Deflorio-Barker, C. Lyttle, J. Solway, and A. Rzhetsky. Associations between environmental quality and adult asthma prevalence in medical claims data. ENVIRONMENTAL RESEARCH. Elsevier B.V., Amsterdam, NETHERLANDS, 166: 529-536, (2018).

WA-APCD - Washington All-Payer Claims Database

The WA-APCD is the state’s most complete source of health care eligibility, medical claims, pharmacy claims, and dental claims insurance data. It contains claims from more than 50 data suppliers, spanning commercial, Medicaid, and Medicare managed care. The WA-APCD has historical claims data for five years (2013-2017), with ongoing refreshes scheduled quarterly. Workers' compensation data from the Washington Department of Labor & Industries will be added in fall 2018.

Download the attachment for the data dictionary and more information about WA-APCD and the data.

The purpose of the project is to detect unreported Supplemental Security Income (SSI) recipient admissions to Title XIX institutions. A file containing SSN's of SSI recipients (all eligible individuals and members of eligible couples in current pay) will be matched against the Health Care Financing Administration's (HCFA) Minimum Data Set (MDS) database which contains admission, discharge, re-entry and assessment information about persons in Title XIX facilities for all 50 States and Washington, D.C. This database is updated monthly. The match will produce an output file containing MDS data pertinent to SSI eligibility on matched records. This data will be compared back to the SSR data to generate alerts to the Field Offices for their actions.

description:

The data used in the chronic condition reports are based upon CMS administrative enrollment and claims data for Medicare beneficiaries enrolled in the fee-for-service program. These data are available from the CMS Chronic Condition Data Warehouse (CCW), a database with 100 percent of Medicare enrollment and fee-for-service claims data. The Medicare beneficiary population is limited to fee-for-service beneficiaries. We excluded Medicare beneficiaries with any Medicare Advantage enrollment during the year since claims data are not available for these beneficiaries. Also, we excluded beneficiaries who were enrolled at any time in the year in Part A only or Part B only, since their utilization and spending cannot be compared directly to beneficiaries enrolled in both Part A and Part B. Beneficiaries who died during the year are included up to their date of death if they meet the other inclusion criteria.

The data used in the chronic condition reports are based upon CMS administrative enrollment and claims data for Medicare beneficiaries enrolled in the fee-for-service program. These data are available from the CMS Chronic Condition Data Warehouse (CCW), a database with 100 percent of Medicare enrollment and fee-for-service claims data. The Medicare beneficiary population is limited to fee-for-service beneficiaries. We excluded Medicare beneficiaries with any Medicare Advantage enrollment during the year since claims data are not available for these beneficiaries. Also, we excluded beneficiaries who were enrolled at any time in the year in Part A only or Part B only, since their utilization and spending cannot be compared directly to beneficiaries enrolled in both Part A and Part B. Beneficiaries who died during the year are included up to their date of death if they meet the other inclusion criteria.

The Hospice Utilization and Payment Public Use File provides information on services provided to Medicare beneficiaries by hospice providers. The Hospice PUF contains information on utilization, payment (Medicare payment and standard payment), submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number 6-digit provider identification number, and state. This PUF is based on information from CMSs Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2014 and contains 100 percent final-action i.e., all claim adjustments have been resolved, hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
Although the Hospice PUF has a wealth of payment and utilization information about hospice services, the data set also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual hospice providers. The file only contains cost and utilization information. Additionally, the data are not risk adjusted and thus do not account for differences in patient populations. For additional limitations, please review the methodology document available below.

Summary of model objectives.

The data displayed here describes average spending levels during hospitals’ Medicare Spending per Beneficiary (MSPB) episodes by Medicare claim type. The data presented on Hospital Compare provide price-standardized, non-risk-adjusted values for hospital spending by claim type because risk adjustment is done at the episode level rather than at the service category/claim level. An MSPB episode includes all Medicare Part A and Part B claims paid during the period from 3 days prior to an inpatient hospital admission through 30 days after discharge.

NCHS has linked data from various surveys with Medicare program enrollment and health care utilization and expenditure data from the Centers for Medicare & Medicaid Services (CMS). Linkage of the NCHS survey participants with the CMS Medicare data provides the opportunity to study changes in health status, health care utilization and costs, and prescription drug use among Medicare enrollees. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with End-Stage Renal Disease.

This dataset tracks the updates made on the dataset "NCHS Survey Data Linked to Centers for Medicare & Medicaid Services (CMS) Medicaid Enrollment and Claims Files" as a repository for previous versions of the data and metadata.

The Agency for Healthcare Research and Quality (AHRQ) created SyH-DR from eligibility and claims files for Medicare, Medicaid, and commercial insurance plans in calendar year 2016. SyH-DR contains data from a nationally representative sample of insured individuals for the 2016 calendar year. SyH-DR uses synthetic data elements at the claim level to resemble the marginal distribution of the original data elements. SyH-DR person-level data elements are not synthetic, but identifying information is aggregated or masked.

This release contains the Basic Stand Alone (BSA) Inpatient Public Use Files (PUF) named CMS 2008 BSA Inpatient Claims PUF with information from 2008 Medicare inpatient claims. This is a claim-level file in which each record is an inpatient claim incurred by a 5 percent sample of Medicare beneficiaries.

This dataset contains data for the Healthcare Payments Data (HPD) Snapshot visualization. The Enrollment data file contains counts of claims and encounter data collected for California's statewide HPD Program. It includes counts of enrollment records, service records from medical and pharmacy claims, and the number of individuals represented across these records. Aggregate counts are grouped by payer type (Commercial, Medi-Cal, or Medicare), product type, and year. The Medical data file contains counts of medical procedures from medical claims and encounter data in HPD. Procedures are categorized using claim line procedure codes and grouped by year, type of setting (e.g., outpatient, laboratory, ambulance), and payer type. The Pharmacy data file contains counts of drug prescriptions from pharmacy claims and encounter data in HPD. Prescriptions are categorized by name and drug class using the reported National Drug Code (NDC) and grouped by year, payer type, and whether the drug dispensed is branded or a generic.