Prior to 2022, Home Health Agencies (HHA) billed Medicare for partial payment before an episode of care was complete by submitting a Request for Anticipated Payment or RAP that would later be replaced by a traditional Medicare claim once the episode of care ended(1).
Medicare telehealth is remote care typically using audio and video technology, and in some cases audio only. Telehealth policy has a history of complexity and nuance that has changed rapidly since the beginning of the COVID-19 Public Health Emergency (PHE).
Medicaid waivers are used by states to waive federal requirements and build their own programs. This article provides a list of helpful reference materials associated with specific waiver types with a particular focus on Medicaid waivers available in CMS Research Identifiable Files (…
This is a short primer which gives viewers a basic intro to operational health care data sources commonly used for research. Data sources include administrative ‘claims’ data (which could be from Medicare, Medicaid, or other insurance) and electronic health record, or EHR, data (which includes…
This is the first video in a series of three intro videos on health care coding systems and how we can understand them for research. This video covers diagnosis codes, particularly International Classification of Disease, or ICD/ICD-10-CM.
This is the second video in a series of three intro videos on health care coding systems and how we can understand them for research. This video covers procedure codes: Current Procedural Terminology, or CPT; Healthcare Common Procedural Coding System, or HCPCs; and International Classification…
This is the third video in a series of three intro videos on health care coding systems and how we can understand them for research. This video covers various coding systems other than diagnosis or procedure codes, including provider identifiers, drug identifiers, geography, and other codes.…
Emergency department (ED) utilization serves as a foundational metric across health services research. Because ED visits are high-cost and high-intensity, the identification of these events is critical for measurement and evaluation of healthcare quality(1). Health researchers rely…
The monthly buy-in indicators in the Medicare Master Summary Beneficiary File (MBSF) flag concurrent Medicare and Medicaid enrollment, commonly called “dual eligibility”. It came to my attention that the MBSF indicates an…
When analyzing data for research, it is sometimes necessary to code time windows. In this article we present several examples of programming common administrative healthcare data analytics that involve time in SAS.