Distilling millions of records into meaningful measures requires meticulous attention to detail; from initial specifications to final programming, precision is everything. As an analyst, my reputation rests on the accuracy of my work, and I need to feel…
Part C encounter RIF data includes two types of records: service records and chart reviews. Medicare Advantage Organizations (MAOs) perform retrospective reviews of their beneficiaries’ medical records to identify diagnoses that were not originally submitted by providers or were…
The Claims Processing Manual (CPM) is the rulebook for submitting claims to CMS. It covers a wide range of medical coding instructions by clinical setting and form.
Medicare fee-for-service (FFS) research identifiable files (RIFs) include both approved and denied claims as well as claims that are denied in part. Claim denials are common, surprisingly complicated, and important for researchers to consider. The choice to include or exclude them…
The Master Beneficiary Summary File: Base file (MBSF: Base), a research identifiable file offered by CMS, contains two annual race variables: the Beneficiary Race Code and the Research Triangle Institute (RTI) Race Code.
Converting raw data into research insights requires the creation of an analytic file – a refined dataset customized for a specific study. Building these files involves aggregating large-scale data into target units, such as hospitals(1) or individual patients(2). Though the process…
The Centers for Medicare and Medicaid Services (CMS) collects service-level encounter data from Medicare Advantage Organizations (MAOs) for the purpose of recording diagnoses used for risk adjusted payments to…