ResConnect

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  1. Difference between Proposed and Final Rule Files

    A number of CMS Limited Data Set (LDS) files are released first as a Proposed Rule file and then as a Final Rule file. These files include the MedPAR, Hospital Outpatient Prospective Payment System (OPPS), Hospital Outpatient Prospective Payment System ...

  2. Medicare Ambulatory Surgical Centers (ASCs) in the Claims Data

    Medicare defines an Ambulatory Surgical Center (ASC) as a distinct entity that operates exclusively for the purpose of furnishing outpatient surgical services to patients. The ASC must have an agreement with CMS that was obtained in accordance with 42 CFR ...

  3. Differences between the Inpatient and MedPAR Files

    Background 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 ...

  4. MAX Provider Charisteristics File (MAXPC): Linking to Medicare Provider Numbers

    MAX data files include state provider identification codes that are state-specific. No central repository exists that would allow institutional providers, physicians or other professionals to be identified. Beginning with the MAX 2009 files, the NPI ...

  5. Sources for Managed Care Enrollment and Penetration Rates

    Background Medicare managed care enrollment has fluctuated over the years and is a frequently requested statistic. Often researchers are interested in penetration rates or the percentage of Medicare beneficiaries that are enrolled in a Medicare managed ...

  6. CMS Research Identifiable Files Request Process and Timeline

    The attached flowchart illustrates the various steps of the CMS identifiable data request packet process. The process involves several organizations, including the researchers, the Research Data Assistance Center (ResDAC), CMS, and the data distributor. ...

  7. Diagnosis and Procedure Coding Resources

    Background Understanding the appropriate procedure and diagnosis codes for a particular study question is an important part of analyzing Medicare data. These codes are very specific and can change from year to year as new codes are added and others are ...

  8. Overview of the NPPES/NPI Downloadable File

    The National Provider Identifier The National Provider Identifier (NPI) is unique identification number for health care providers, including both organizations and individuals. The NPI is a 10-position numeric identifier that allows researchers to ...

  9. Part D Formulary Information in the CMS Data Files

    Background Detailed information about Medicare Part D drug plan formularies is available in two CMS data files. There are important differences in the files that are outlined below, including  whether or not the files can be linked to other data sources. ...

  10. Medicare Claims and Enrollment Data Linked to Cancer Registry Data

    Researchers who are interested in studying cancer may want to consider the SEER-Medicare linked data files. The Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute provides information on cancer diagnoses, including ...

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