Outpatient Prospective Payment System (OPPS)

Purveyor: Centers for Medicare and Medicaid Services

Years in the DataCore: 2012-2017

Years of data owned: 2012-2017

Unit of data: Claim

Dataset website: https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/HospitalOPPS.html

General description: OPPS contains final action, fee-for-service claims data submitted by institutional outpatient providers. Examples of institutional outpatient providers include hospital outpatient departments, rural health clinics, renal dialysis facilities, outpatient rehabilitation facilities, comprehensive outpatient rehabilitation facilities, and community mental health centers. 

Inpatient Prospective Payment System (IPPS)

Purveyor: Centers for Medicare and Medicaid Services

Years in the DataCore: 2012-2017

Years of data owned: 2012-2017

Unit of data: Claim

Dataset website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/index.html

General description: These files contain claims from institutional providers and/or settings that are covered by the Medicare Part A. In addition, claims for institutional-based services covered by the Medicare Part B benefit (e.g., home health, hospital outpatient) appear in the institutional claims file.

Master Beneficiary Summary File (MBSF) (Denominator)

Purveyor: Centers for Medicare and Medicaid Services

Years in the DataCore: 2012-2017

Years of data owned: 2012-2017

Unit of data: Claim

Dataset website: https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/MBSF-LDS.html

General description: This includes the base Medicare A/B/D segment which includes beneficiary enrollment information, such as the beneficiary unique identifier, state and county codes, ZIP code, date of birth, date of death, sex, race, age, monthly entitlement indicators (A/B/C/D), reasons for entitlement, and monthly managed care indicators (yes/no). As of 2006, it includes variables specific to enrollment in Part D, and as of 2017 Part C was added. The MBSF has four segments: 1) Beneficiary Summary File or Medicare enrollment, 2) Chronic Conditions, 3) Cost & Utilization, and 4) NDI death information with ICD-10 cause of death through 2008. 

Carrier (Fee-For-Service)

Purveyor: Centers for Medicare and Medicaid Services

Years in the DataCore: 2012-2017

Years of data owned: 2012-2017

Unit of data: Claim

Dataset website: https://www.resdac.org/cms-data/files/carrier-ffs

General description: This is also known as the Physician/Supplier Part B claims file and contains final action fee-for-service claims submitted on a CMS-1500 claim form. Most of the claims are from non-institutional providers, such as physicians, physician assistants, clinical social workers, nurse practitioners, and free-standing facility claims. 

Skilled Nursing Facility (SNF)

Purveyor: Centers for Medicare and Medicaid Services

Years in the DataCore: 2012-2017

Years of data owned: 2012-2017

Unit of data: Claim

Dataset website: https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/LimitedDataSets/SkilledNursingFacilityMEDPARLDS.html

General description: This file contains information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The SNF public use file 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 (six-digit provider identification number), Resource Utilization Group (RUG), and state of service. 

Home Health (HHA)

Purveyor: Centers for Medicare and Medicaid Services

Years in the DataCore: 2012-2017

Years of data owned: 2012-2017

Unit of data: Claim

Dataset website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HomeHealthPPS/index.html

General description: This file contains data from the Healthcare Cost Report Information System (HCRIS) Data Set and includes final action fee-for-service claims submitted by home health agencies.

Hospice (HOSP)

Purveyor: Centers for Medicare and Medicaid Services

Years in the DataCore: 2012-2017

Years of data owned: 2012-2017

Unit of data: Claim

Dataset website: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/index.html

General description: This file contains final action claims submitted by hospice providers. Once a beneficiary elects hospice, all hospice-related claims will be found in this file, regardless of whether the beneficiary is in Medicare fee-for-service or in a Medicare managed care plan.