Help and resources for working with health care data
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).
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 (RIF). These links work at the time of writing, but availability of these websites may change over time.
Published on Sep 21, 2026 by Rebecca Vick
It came to my attention that the MBSF indicates an unbelievably low dual eligibility rate for Puerto Rico.
Published on Aug 31, 2026 by Samantha Saykao
Changes in coverage and claim submission requirements can have significant impact on claims research data.
Published on Aug 17, 2026 by Rebecca Vick
Distilling millions of records into meaningful measures requires meticulous attention to detail; from initial specifications to final programming, precision is everything.
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 is complex, it is a cornerstone of well-conducted research. This article offers practical guidance and key considerations for constructing these essential datasets.
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 MAOs(2). Unlike a fee-for-service (FFS) claim, an encounter record is not a direct record of payment and not used for billing purposes. Thus, Encounter Research Identifiable Files (RIFs) have some unique aspects to consider: