Medicare Claims

The Medicare Claims Files contain information collected by Medicare to pay for health care services provided to a Medicare beneficiary. Data are available for each institutional and non-institutional claim type, which each record being a claim. Some of the information contained within these utilization files includes:

  • procedure and diagnosis information
  • dates of service
  • revenue center detail
  • payment and charge amounts
  • beneficiary demographic information
  • limited professional provider and facility data

Inclusion of Hospital and Skilled Nursing Stays in the RIF Annual MedPAR and Claims Data

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Researchers working with the Research Identifiable (RIF) versions of the MedPAR or Inpatient and Skilled Nursing Facility (SNF) claims may find records that do not appear to correspond to the year of the file. These instances can usually be explained by how stays or claims are included in the files during file creation.

Medicare Managed Care Enrollees and the Medicare Utilization Files

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Even though the Medicare utilization files for the most part contain fee-for-service claims, some managed care claims may appear in the files. It is important for researchers to understand the type of managed care claims that may be found in the data in order to make the necessary exclusions from their study population. This document provides of an overview of identifying managed care enrollees and their utilization in the Medicare utilization files.

Differences between the Inpatient and MedPAR Files

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Researchers who are interested in studying inpatient utilization (e.g. hospital stays) have two options: the Inpatient claims file or the Medicare Provider Analysis and Review (MedPAR) file. It is important to note that the differences between the two files will vary depending on whether a researcher is interested in the Research Identifiable File (RIF) or Limited Data Set (LDS) versions of the two files.
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