Data File Search
The PY14 Risk Score Files includes six segments: a base file, four files with outputs from Part C models and one for Part D model outputs. All files can be linked to other CCW files via the Bene_ID.
The files include:
PY14 Base file:
Part C monthly risk payment scores
Part C monthly model segment codes
Part D model risk payment scores
Part D monthly model segment codes
Part C monthly institutional indicators
Part C community and institutional non-monthly model payment scores
Part D non-monthly model payment...
Program:
Medicare
What does this file include? (variable highlights)Practice IdentifierQuality and Resource Use Report (QRUR) informationVM informationBenchmark informationSpecial considerationsData documentation is specific to each performance year.This RIF includes thousands of records with hundreds of variables.Can be linked to provider NPI in the VM NPI-Practice-Level RIFTwo additional VM program RIFs are available:VM NPI-Practice-Level RIFVM Beneficiary-Level File RIF
Program:
Medicare
What does this file include? (variable highlights)Beneficiary identifiersPractice identifier for the practice to which the beneficiary was attributedNumber and percent of primary care services provided to the beneficiary that were billed by the practiceHCC percentile risk scoreSpecial considerationsData documentation is specific to each performance year.This RIF can be linked to any other CMS file that includes the Bene ID.Two additional VM program RIFs are available:VM Practice-Level RIFVM NPI-Practice-...
Program:
Medicare
What does this file include? (variable highlights)quarterly assignmentdate of birthdate of deathgenderracemonthly Medicare eligibility informationencrypted beneficiary identifier link to the Shared Savings Program Provider-Level RIFSpecial considerationsThis file can be linked to any other CMS file that includes the Bene ID.Shared Savings Program RIFs do not include Pioneer ACO, Next Generation ACO or Comprehensive End Stage Renal Disease Care (CEC) data.The Shared Savings Program Beneficiary-Level RIF was...
Program:
Medicare
What does this file include? (variable highlights)ACO name and start dateNational Provider Identifier (NPI)/nameTaxpayer Identification Number (TIN)/nameCMS Certification Number (CCN)facility type - institutionspractice type (specialty) - individualscounty primarily servicedSpecial considerationsShared Savings Program RIFs do not include Pioneer ACO, Next Generation ACO or Comprehensive End Stage Renal Disease Care (CEC) data.All technical questions related to the Shared Savings Program should be directed to...
Program:
Medicare
What does this file include?Provider file
Pioneer ACO ID
Tax identification number
Provider specialty code
Beneficiary file
Bene ID
Pioneer ACO ID
Aggregated expenditures and claim counts
Settlement file
Pioneer ACO ID
Beneficiary counts
Performance year expenditures and savings
Special considerations
Each file needs to be specified separately on a data request.
Only the Pioneer ACO Beneficiary file can be linked to other CMS data via the Bene ID.
Program:
Medicare
What does this file include? (variable highlights)
The MD-PPAS has been updated to version 2.3 from version 2.2 to reflect the following changes:
The data now include variables on the percentage of a provider’s line items that are performed in eight place-of-service categories.
The data use a corrected form of the zip-code-to-CBSA crosswalk to assign providers to CBSA based on the zip code reported on their submitted claims. This correction resulted in a small percentage of providers that exist in both...
Program:
Medicare
What does this file include?Beneficiary level records
SNP enrollment
Body Mass Index (BMI)
Disease screening indicators
Chronic condition treatment indicators
Counts of specific procedures
Program:
Medicare
This file include:
Diagnosis codes (ICD diagnosis)
Procedure codes (ICD procedure)
Resouce Utilization Group codes (RUGs)
Admission/discharge dates
Organization NPI number only
No payment variables
Part C/Medicare Advantage benefit package and contract number
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness programs). Encounter data will include...
Program:
Medicare
This file includes:
diagnosis (ICD diagnosis) codes
HCPCS code
Revenue center codes, dates, unit counts
Part C Benefit Package and Contract number
Organization NPI number
No payment information
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness programs). Encounter data will include records for these additional items and services provided under the plan...
Program:
Medicare
This file includes:
Admission, discharge dates
diagnosis (ICD diagnosis) codes
procedure (ICD procedure) codes
diagnostic related group (DRG) codes
patient discharge status code
organization NPI
Part C/Medicare Advantage benefit package and contract number
Revenue center codes, dates, unit counts
No payment variables are available
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental...
Program:
Medicare
This file includes:
Part C Benefit Package and Contract number
diagnosis (ICD diagnosis) codes
HCPCS code
Revenue center codes, dates, unit counts
Organization NPI
NPI for line rendering physician
Patient discharge status code
No payment variables
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness programs). Encounter data will include records for these...
Program:
Medicare
This file includes:
Part C Benefit Package and Contract number
diagnosis (ICD diagnosis)
HCPCS code
Organization NPI
NPI for line supplier
Date of service (line date)
Special considerations:
Many Medicare Advantage Plans offer extra coverage in addition to services covered under traditional fee-for-service Medicare (e.g., vision, hearing, dental, and/or health and wellness programs). Encounter data will include records for these additional items and services provided under the plan.
Program:
Medicare
This file includes:
Part C Benefit Package and Contract number
diagnosis (ICD diagnosis)
HCPCS code
Date of service (line date)
NPI for line rendering physician
No payment information
Program:
Medicare
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
End-of-life care decisions
Program:
Medicare, Medicaid
What does this file include?
Resource Utilization Group (RUG) code
Clinical status measures
Physical functioning assessment
Psychological status measures
Psycho-social functioning measure
End-of-life care decisions
Program:
Medicare, Medicaid
What does this file include?
HIPPS code
socio-demographic variables
information on patient home environment and informal caregivers
health status, including diagnosis codes
functional status
psychosocial status
health service utilization
emergent care
hospital admission
Special considerations
The Medicare Prescription Drug Improvement and Modernization Act of 2003 (MMA) suspended required completion for non-Medicare and non-Medicaid patients.
Program:
Medicare, Medicaid
What does this file include? (variable highlights)
Pre-hospitalization living situation
Co-morbid conditions
Communication status
Functional status
Program:
Medicare
Healthcare providers/populations addressed by specific, individual surveys include:
Hospital
Home Health
Home and Community Based Services
Fee-for-Service
Medicare Advantage & Part D Plan (PDP)
In-Center Hemodialysis
Nationwide Adult Medicaid
Hospice
Accountable Care Organizations
Outpatient and Ambulatory Surgery
Merit-based Incentive Payment System quality payment program
Measures of beneficiary experience focus on the patient experience or perception rather than patient satisfaction. Focus areas...
Program:
Medicare
What does this file include?
Eligibility, enrollment variables
Aggregated cost and use
Medicare: FFS, PDE includes FFS and MA
Medicaid: FFS, managed care encounter where available
Prescription Drug service utilization reported for classes of drugs
All four files are released for approved MMLEADS data requests
Beneficiary file
Medicare Services file
Medicaid Services file
Conditions file
Special considerations
External resource of detailed information on MMLEADS files and structure: CCW MMLEADS User Guide...
Program:
Medicare, Medicaid
The NHATS interview data include:
Residence
Health conditions
Housing/household
Functional status
Insurance
Labor force participation
The NHATS interview data are linked to CMS Medicare claims data for information on healthcare use.
Special considerations
Pre-approval is required from the NHATS program prior to submitting a CMS data request for the Medicare linked files.
The NHATS web site has information on obtaining this restricted data.
Program:
Medicare
What does this file include? (variable highlights)
HRS data include:
Demographic and background information, including household
Physical and mental health
Cognition
Functional limitations
Employment
Disability
Health insurance
Assets and Income
Wills, including advanced directives
Linked files include:
Medicare denominator/Beneficiary Summary File (BSF)
Medicare fee-for-service (FFS) claims
Inpatient, MedPAR, Outpatient, Durable Medical Equipment (DME), Carrier, Skilled Nursing Facility, Home Health,...
Program:
Medicare
HOS variables contain the following information in a baseline survey and two year follow-up survey
Demographic information including primary language
Disability status
Physical and mental health status
HEDIS Effectiveness of Care measures
Health related quality of life (HRQOL)
Special considerations
CMS will provide additional file specifications to researchers with approved data requests.
Information on the survey and data can be found on the Medicare Health Outcomes Survey web site.
Program:
Medicare