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. 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 ...

  3. 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 ...

  4. Unique Physician Identification Numbers (UPINs) and Associated Files

    Unique Physician Identification Numbers (UPIN s) were assigned to physicians and other healthcare professionals when they enrolled in Medicare.   For Medicare claims submitted by physicians/practitioners, UPINs are used to identify the individual who ...

  5. Medicare and Medicaid Statistical and Summary Data

    The following Medicare/Medicaid statistical and summary data resources address some of the most common requests for this type of information. These are by no means exhaustive. CMS Data Navigator  The  CMS Data Navigator  is provides options to locate ...

  6. Medicare Data Finder and Crosswalk Files

    Researchers needing information on finder and crosswalk files should consult the CCW “Finder File Encryption Policy” article found on the CCW website. In addition to the information on the required encryption, the article includes:                -finder ...

  7. How to Identify Hospital Claims for Emergency Room Visits in the Medicare Claims Data

    Hospitals submit claims containing ER services on a CMS-1450 form (aka UB-04). Their claims containing ER charges will be found in the inpatient claims data (Inpatient file or MedPARfile) and the outpatient claims file. Claims in the Outpatient and ...

  8. Identifying Hospitals that Receive Disproportionate Share (DSH) Payments

    Medicare participating hospitals that receive Disproportionate Share (DSH) payments can be identified using information contained in the Medicare Cost Reports. Researchers interested in this information may follow the below steps to access DSH information ...

  9. Identifying Observation Stays for Those Beneficiaries Admitted to the Hospital

    Most charges for observation stays that result in an inpatient admission within 3 days of the observation period will be found in the Inpatient file. Two exceptions are described in the CMS Medicare Claims Processing Manual, section 40.3.B. These include ...

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

    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 ...

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