RIF Medicare Quarterly Data

RIF Medicare Quarterly Data

Current Version Date: 
09/27/2016

Researchers may now request data on a quarterly basis, in addition to the annual files.

Data available on a quarterly basis includes Medicare Research Identifiable FFS claims (Inpatient, Outpatient, Home Health Agency, Hospice, Skilled Nursing Facility, Carrier, and Durable Medical Equipment) and the Master Beneficiary Summary File: Base A/B segment.

The quarterly files are static and include all claims received through the end of the quarter based on the Claim Thru Date.  Similar to the annual files, quarterly files reflect final action claims with all debits, credits, and adjustments applied.  

Quarterly files have an approximately 4.5-month lag (3 months for claim maturity and 1.5 months for reconciliation, validation, and to produce the extracts). For example, the Q1 file will represent claims received through June 30th (3 months claim maturity) for services provided between January 1 and March 31 (Q1).  The Q1 2015 Medicare FFS files will be available in mid-August 2015 at approximately a 93% claims maturity for the quarter. Table 1 provides a timeline for the release of quarterly data. Each quarterly file is a standalone file. In order to refresh quarterly data, the annual file will need to be requested. 

Table 1. Quarterly Data Extract Schedule

Quarter 1

Quarter 2

Quarter 3

Quarter 4

Jan –March available to extract mid-August

April-June available to extract  mid-November

July-Sept available to extract mid-Feb

Oct-Dec available to extract mid-May

Process and Pricing

Quarterly data can be requested as part of a new project or as an amendment to an existing project.  All initial requests for quarterly data, as well as requests for subsequent quarters of data, should be submitted to ResDAC. 

Physical Receipt Pricing

The initial quarterly extract will use the standard pricing structure.  Each subsequent extract will be priced at 50% of the data file cost.  Please note that this assumes no change to the cohort.

VRDC Pricing

CMS charges $5,000 per year of the seat. The quarterly data fee includes access to all quarters available during the time the seat is active.  Please see the CMS Price Sheet for more information.

Annual Data

CMS will continue to offer the annual claim and enrollment files that are created 12 months after the close of the calendar year when the files are considered 99.9% complete. The annual Medicare claim and enrollment files are generally available for distribution in February at a 14-month lag. (EG: 2015 annual file would become available for distribution in February 2017.) For quarterly data requestors, CMS will offer the annual files at 50% of the standard annual rate for physical data and for no additional charge for VRDC seat holders.

 

Summary

  • Quarterly data are only available for the Medicare Research Identifiable File claims and enrollment files.
  • Quarterly files do not reflect the same run off period as the annual research files, resulting in different claim completion percentages.
  • Quarterly and annual claims files reflect the final action claims at the time they are extracted.

 

 

Note There is no change to the files that the following requestors are eligible to receive: Qualified Entities, State Research, and CMMI.

 

 

 

Article Number: 
205
This work was performed under CMS Contract Number HHSM-500-2013-00166C
Related Data File Families: 
Related Data Request Processes: 
Related Data Request Materials: