Others titles
- Medicare Providers Services for Moratorium on New Providers
- CMNS Moratorium on New Providers
Keywords
- Moratoria Provider Services
- Moratoria Provider Utilization Data
- Medicare Claims Data
- CMS Fee for Service Data
- CMS Data
- Fee for Service Beneficiaries
- Medicare Provider Services
Moratoria Provider Services and Utilization at State and County Level
Moratoria Provider Services and Utilization dataset provides information on the number of Medicare providers servicing a geographic region and the number of Medicare beneficiaries who use a health service area. The dataset can also be used to reveal the degree to which use of a service is related to the number of providers servicing a geographic region as well as to determine which geographic and health service areas might be considered for a moratorium on new providers.
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Description
The Moratoria Provider Services and Utilization data shows national, state and county level provider services and utilization data for selected health service areas. The analysis is based on paid Medicare claims data from the CMS Integrated Data Repository (IDR). The IDR contains Medicare & Medicaid claims, beneficiary data, provider data and plan data. Claims data are analyzed for a 12-month reference period. Results are updated quarterly to reflect a more recent 12-month reference period.
The Moratoria Provider Services and Utilization methodology is different from other public use data with respect to determining the geographic location of a provider. In this analysis, claims are used to define the geographic area(s) served by a provider rather than the provider’s practice address. Further, a provider is defined as “serving a county” if, during the one-year reference period, the provider had paid claims for more than 10 beneficiaries located in a county. A provider is defined as “serving a state” if that provider serves any county in the state.
The Moratoria Provider Services and Utilization methodology is also different from other public use data with respect to determining the number of Medicare beneficiaries who are enrolled in a fee-for-service (FFS) program. In this analysis, an FFS beneficiary is defined as being enrolled in Part A and/or Part B with a coverage type code equal to “9” (FFS coverage) for at least one month of the 12-month reference period. Beneficiaries must not have a death date for that month and must have a non-missing zip code so that they can be assigned to a county. Other public use data may define an FFS beneficiary using different criteria, such as requiring the beneficiary to be enrolled in the FFS program every month during the reference period.
There are four exclusionary criteria imposed on the data. In particular:
1. The following United States territories, commonwealths, and freely associated states are excluded: American Samoa (AS); Micronesia (FM); Guam (GU); Northern Mariana Islands (MP); Puerto Rico (PR); and the U.S. Virgin Islands (VI).
2. If a beneficiary’s county of residence cannot be determined, that beneficiary is excluded. (This generally represents a very small percent of the population (<1%).
3. Providers are excluded if they had paid claims for 10 or fewer beneficiaries located in the county.
4. Counties are excluded if 10 or fewer beneficiaries who had paid claims resided in the county.
About this Dataset
Data Info
Date Created | 2014-10-01 |
---|---|
Last Modified | 2020-01-07 |
Version | 2020-01-07 |
Update Frequency |
Quarterly |
Temporal Coverage |
2014-10-01 to 2018-12-31 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Moratoria Provider Services, Moratoria Provider Utilization Data, Medicare Claims Data, CMS Fee for Service Data, CMS Data, Fee for Service Beneficiaries, Medicare Provider Services |
Other Titles | Medicare Providers Services for Moratorium on New Providers, CMNS Moratorium on New Providers |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Reference_Period | Refers to the time period for which the claims have been analyzed | string | required : 1 |
Type_of_Service_Provided | Type of service provided by the Provider in that county or state. These include Ambulance services which are part of Medicare Part B, Home health services which are part of Medicare Part A, Skilled nursing facilities services which are part of Medicare Part A, | string | required : 1 |
Aggregation_Level | The geographic level at which the data has been collected | string | required : 1 |
State_Abbreviation | Abbreviation of the state for which the services are rendered. | string | required : 1 |
State_FIPS_Code | FIPS (Federal Information Processing Standards) of the state. | integer | - |
County | Name of the County for which the services are rendered | string | - |
County_FIPS_Code | FIPS (Federal Information Processing Standards) of the state. | integer | - |
Number_of_Fee_for_Service_Beneficiaries | A Fee-for-Service beneficiary is defined as being enrolled in Part A and/or Part B with a coverage type code equal to “9” (FFS coverage) for at least one month of the 12-month reference period. Beneficiaries must not have a death date for that month, and must have a non-missing zip so they can be assigned to a county. | integer | level : Ratiorequired : 1 |
Number_of_Providers | Claims are used to define the geographic area(s) served by a provider rather than the provider’s practice address. A provider is defined as “serving a county” if, during the one-year reference period, the provider had paid claims for more than 10 beneficiaries located in a county. A provider is defined as “serving a state” if that provider serves any county in the state. | integer | level : Ratio |
Average_Number_of_Users_Per_Provider | “Users” are the subset of FFS beneficiaries who have a paid claim for a service. This number is divided by the number of providers to obtain the average number of users per provider | number | level : Ratio |
Percentage_of_Users_Out_of_FFS_Beneficiaries | The proportion of Fee-For-Service beneficiaries who have a paid claim for a service | number | level : Ratiorequired : 1 |
Number_OF_Users | Indicates the number of users. | integer | level : Ratio |
Average_Number_of_Providers_Per_County | For the nation, the average number of providers per county is the average number of providers across the U.S. counties (and the District of Columbia) included in the analysis. For each state, this number is the average across that state’s counties. For each county, it is the number of providers in the county. | number | level : Ratio |
Number_Of_Dual_Eligible_Users | Dual eligible users are defined as the subset of FFS beneficiaries who have paid claims for Medicare services and are defined as Beneficiary Dual Status Codes (01-06). | integer | level : Ratio |
Percentage_Of_Dual_Eligible_Users_Out_Of_Total_Users | The proportion of dual eligible users divided by the total number of users. | number | level : Ratio |
Percentage_Of_Dual_Eligible_Users_Out_Of_FFS_Beneficiaries | The proportion of dual eligible users divided by dual eligible fee for service beneficiaries. | number | level : Ratio |
Total_Payment | For Part A services, total payments are calculated from the claim level paid amounts. For IDTF Part A, the total payments reflect the payment for all services rendered on the date of service (i.e., claim level payment), which may be greater than the payment for the specific services included in IDTF Part A. For Part B services, total payments are calculated from the claim line level paid amount. | integer | level : Ratio |
Percentage_FFS_Beneficiaries_By_0_to_2_Providers_Serving_County | Percentage of the Fee-for-Service beneficiaries which are served by 0 to 2 providers in that specific county | number | level : Ratio |
Percentage_FFS_Beneficiaries_By_3_to_4_Providers_Serving_County | Percentage of the Fee-for-Service beneficiaries which are served by 3 to 4 providers in that specific county | number | level : Ratio |
Percentage_FFS_Beneficiaries_By_5_to_9_Providers_Serving_County | Percentage of the Fee-for-Service beneficiaries which are served by 5 to 9 providers in that specific county | number | level : Ratio |
Percentage_FFS_Beneficiaries_By_10_to_19_Providers_Serving_County | Percentage of the Fee-for-Service beneficiaries which are served by 10 to 19 providers in that specific county | number | level : Ratio |
Percentage_FFS_Beneficiaries_By_More_Than_20_Providers_Serving_County | Percentage of the Fee-for-Service beneficiaries which are served by more than 20 providers in that specific county | number | level : Ratio |
Number_Of_Fee_For_Service_Beneficiaries_Percentage_Change | Change in percentage for number of fee for service beneficiaries. | number | level : Ratio |
Number_Of_Providers_Percentage_Change | Change in percentage in average number of users per provider. | number | level : Ratio |
Average_Number_Of_Users_Per_Provider_Percentage_Change | Change in percentage for average number of users per provider. | number | level : Ratio |
Percentage_Of_Users_Out_Of_FFS_Beneficiaries_Percentage_Change | Change in percentage of users out of FFS Beneficiaries. | number | level : Ratio |
Number_Of_Users_Percentage_Change | Change in percentage of number of users. | number | level : Ratio |
Average_Number_Of_Providers_Per_County_Percentage_Change | Change in percentage of average number of providers per county. | number | level : Ratio |
Number_Of_Dual_Eligible_Users_Percentage_Change | Change of percentage in number of dual eligible users. | number | level : Ratio |
Percentage_Of_Dual_Eligible_Users_Out_Of_Total_Users_Percentage_Change | Change of percentage in percentage of dual eligible users out of total users. | number | level : Ratio |
Perc_Of_Dual_Eligi_Users_Out_Of_Dual_Elig_FFS_Benefi_Perc_Change | Change of percentage in percentage of dual eligible FFS beneficiaries. | number | level : Ratio |
Total_Payments_Percentage_Change | Change of percentage in total payments. | number | level : Ratio |
Data Preview
Reference Period | Type of Service Provided | Aggregation Level | State Abbreviation | State FIPS Code | County | County FIPS Code | Number of Fee for Service Beneficiaries | Number of Providers | Average Number of Users Per Provider | Percentage of Users Out of FFS Beneficiaries | Number OF Users | Average Number of Providers Per County | Number Of Dual Eligible Users | Percentage Of Dual Eligible Users Out Of Total Users | Percentage Of Dual Eligible Users Out Of FFS Beneficiaries | Total Payment | Percentage FFS Beneficiaries By 0 to 2 Providers Serving County | Percentage FFS Beneficiaries By 3 to 4 Providers Serving County | Percentage FFS Beneficiaries By 5 to 9 Providers Serving County | Percentage FFS Beneficiaries By 10 to 19 Providers Serving County | Percentage FFS Beneficiaries By More Than 20 Providers Serving County | Number Of Fee For Service Beneficiaries Percentage Change | Number Of Providers Percentage Change | Average Number Of Users Per Provider Percentage Change | Percentage Of Users Out Of FFS Beneficiaries Percentage Change | Number Of Users Percentage Change | Average Number Of Providers Per County Percentage Change | Number Of Dual Eligible Users Percentage Change | Percentage Of Dual Eligible Users Out Of Total Users Percentage Change | Perc Of Dual Eligi Users Out Of Dual Elig FFS Benefi Perc Change | Total Payments Percentage Change |
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | NATION + TERRITORIES | --ALL-- | 42001418 | 9077 | 517 | 11 | 4696934 | 42 | 1345354 | 0 | 0 | 4259554726 | 3 | 5 | 15 | 22 | 55 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | |||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | AL | 1.0 | 795482 | 152 | 630 | 12 | 95760 | 13 | 29175 | 0 | 0 | 93481341 | 0 | 3 | 34 | 52 | 10 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | ||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | AK | 2.0 | 89119 | 30 | 239 | 8 | 7164 | 5 | 2237 | 0 | 0 | 5481429 | 17 | 32 | 52 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | ||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | AZ | 4.0 | 785705 | 150 | 467 | 9 | 70049 | 52 | 11160 | 0 | 0 | 48421240 | 0 | 1 | 1 | 21 | 77 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | ||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | AR | 5.0 | 525259 | 94 | 597 | 11 | 56105 | 8 | 18965 | 0 | 0 | 48566534 | 4 | 27 | 41 | 28 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | CA | 6.0 | 3821410 | 350 | 1106 | 10 | 387047 | 83 | 160625 | 0 | 0 | 382153197 | 0 | 1 | 4 | 9 | 86 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | ||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | CO | 8.0 | 559566 | 130 | 345 | 8 | 44795 | 15 | 10299 | 0 | 0 | 33373143 | 7 | 8 | 24 | 15 | 46 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | ||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | CT | 9.0 | 520561 | 183 | 422 | 15 | 77231 | 54 | 31765 | 0 | 0 | 75819957 | 0 | 0 | 0 | 0 | 100 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | ||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | DE | 10.0 | 177218 | 94 | 241 | 13 | 22681 | 52 | 4380 | 0 | 0 | 20931534 | 0 | 0 | 0 | 0 | 100 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 | ||
2014-10-01 to 2015-09-30 | Ambulance (Emergency & Non-Emergency) | STATE | DC | 11.0 | 84528 | 24 | 436 | 12 | 10455 | 24 | 4819 | 0 | 0 | 8015649 | 0 | 0 | 0 | 0 | 100 | 0 | 0 | 0 | 0 | 0 | 0 | 0.0 | 0.0 | 0.0 | 0 |