CMS must ensure that all research requests for identifiable (RIF) data have IRB documentation to satisfy the requirements of the Common Rule and the Health Insurance Portability and Accountability Act (HIPAA). This article describes the...
CMS research files do not include beneficiary risk adjustment scores. However, CMS does provide the programming code and instructions to calculate the three risk adjustments that CMS uses as the basis for managed care payment.
Researchers and data users who are working with CMS files may need to map zip code information to CMS carriers and localities. This article describes where to find current and historical versions of the file.
The Centers for Medicare & Medicaid Services (CMS) seeks to ensure the protection of CMS data that are disclosed to external organizations for research purposes. To accomplish this, CMS has developed the Data Privacy Safeguard Program (DPSP). The DPSP reflects the Agency's priorities to both improve data stewardship and to protect the privacy and security of CMS research identifiable files (RIF) that are made available for conducting important research studies.
Part D Event (PDE) files for data years prior to 2010 may include the values of “XX” or “NA” for any of the four Utilization Management variables. This article describes when and why each value was used.
For data years 2006 and forward, dually eligible Medicare beneficiaries are identified in the Medicare Master Beneficiary Summary File, Base segment. Initially available only as a RIF, this file was released as an LDS file in 2016. The monthly variable “Medicare-Medicaid Dual Eligibility” identifies dual status.Dual eligibles are also identified in the Medicaid Analytic Extract (MAX) Personal Summary (PS) file.