Index
A
ADMSN_DT variable 89n3
Affordable Care Act (2010) 11
age group, displaying results by 62-63
AGE_CATS variable 62-63, 125-126
algorithms
about 3, 4, 47-51
creating final enrollment data for remainder of programming 66
creating or retaining data elements for displaying results by certain characteristics 59-66
delimiting claims by continuously enrolled beneficiary population 72-73
diabetic eye exams for beneficiaries with diabetes 116-118
Evaluation and Management visits for beneficiaries with diabetes or COPD 114-116
hospital readmissions for beneficiaries with COPD 118-120
identifying beneficiaries with diabetes or COPD 108-114
identifying continuously enrolled FFS beneficiaries 55-59
measuring emergency department utilization 80-81
measuring E&M payments 95-98
measuring E&M utilization 73-74
measuring inpatient hospital payments 98-100
measuring inpatient hospital utilization 75-79
measuring outpatient visit information 84-85
measuring total Part A payments 100-102
measuring utilization of ambulance services 81-84
measuring utilization of SNF, Home Health Agency, and hospice care 85-87
presenting inpatient length of stay information by state 131-133
presenting mean Medicare Part A payments per beneficiary by state and county 133-135
presenting rates of diabetic eye exams 135-137
presenting selected measurements of utilization, cost to Medicare, and quality outcomes 125-131
transforming base claim and line level data sets into single claim-level files 47-51
ALS (Lou Gehrig's disease) 10
AMB_CARR_SVC variable 83-84
ambulance utilization, presenting 125-127
American Medical Association (AMA) 23, 89n1
A_MO_CNT variable 56
archiving materials for future use 138-139
'Are You a Hospital Inpatient of Outpatient' pamphlet 27n7
B
Balanced Budget Act (1997) 10
Bannister, Wade 89n8
base claim carrier data, transforming into claim-level files 48-51
base claim data sets, transforming into single claim-level files 47-48
beneficiaries
with diabetes or COPD 108-116
with end-stage renal disease (ESRD) 68n2
beneficiary identifier 22-23
BENE_HI_CVRAGE_TOT_MONS variable 56, 57
BENE_HMO_CVRAGE_TOT_MONS variable 56, 57
BENE_ID variable 22, 48, 49, 50, 51, 66, 71, 73, 78, 83, 86, 101-102, 116, 119, 125, 128
BENE_SMI_CVRAGE_TOT_MONS variable 56, 57
black lung disease 12-13
B_MO_CNT variable 56
C
CAHs (critical access hospitals) 75
carrier claims 122n6
carrier file 122n7
CCW (Chronic Conditions Data Warehouse) 68n3, 108, 121n2, 121n3, 121n4, 121n5
Centers for Medicare & Medicaid Service (CMS) 7, 10, 41-42
chiropractic services 10
chronic conditions, identifying
about 105-106, 121n2, 121n5
diabetic eye exams for beneficiaries with diabetes 116-118
Evaluation and Management (E&M) visits for beneficiaries with Diabetes or COPD 114-116
hospital readmissions for beneficiaries with COPD 118-120
identifying beneficiaries with Diabetes or COPD 108-114
peculiarities of Medicare data 107
programming plan 107-108
Chronic Conditions Data Warehouse (CCW) 68n3, 108, 121n2, 121n3, 121n4, 121n5
claim forms 16n11
claims data
See also data
basics of 70-72
commonly retained elements in 22-24
decrypting 46
inpatient 20-21
loading 46-47
receiving 45-46
requesting 40-41
sources of 18, 40-41
structure of 18
CLAIM_SEGMENT variable 86-87
CLAIM_SEGMENT_ID variable 86
CLM_ID variable 48, 49, 50, 51
CLM_LN variable 48, 49
CLM_LOOP macro 100, 109
CLM_LOOP2 macro 111
CMS (Centers for Medicare & Medicaid Service) 7, 10, 41-42
CMS-1450 claim form 20, 21
CMS-1500 claim form 16n11, 20
CNTY_CD variable 64
Comparison of Medicare Beneficiary Counts for Chronic Condition Algorithms 121n3
CONTENRL_AB_2010 variable 57, 58, 59
CONTENRL_HMO_2010 variable 57, 58, 59
COPD, beneficiaries with 108-116
COPD_CARR_SUM variable 111, 113
COPD_FLAG variable 113, 130
COPD_HH_SUM variable 111
COPD_IP_SUM variable 111
COPD_OP_SUM variable 111, 113
COPD_SN_SUM variable 111
costs, to Medicare
about 91-93
basics of 93-94
measuring Evaluation and Management (E&M) payments 95-98
measuring inpatient hospital payments 98-100
measuring total Part A payments 100-102
programming plan 93-94
coverage 11-13
coverage characteristics, displaying results by 59-61
coverage publications, Medicare 27n1
CPT (Current Procedural Terminology) codes 23
creating
data elements for displaying results 59-66
final enrollment data for remainder of programming 66
critical access hospitals (CAHs) 75
Current Procedural Terminology (CPT) codes 23
D
data
See also claims data
See also enrollment data
about 1-2, 17-18
algorithms 47-51
available from CMS 41-42
commonly retained elements in administrative claims data 22-24
completing paperwork 43-45
contacting ResDAC 43-45
Durable Medical Equipment (DME) data 19-20
home health claims data 21
hospice claims data 22
identification of Emergency Department (ED) utilization 25
identification of surgical services 26
inpatient claims data 20-21
master beneficiary summary file 24
outpatient claims data 20
Part B carrier claims data 19
peculiarities of 107
provider data 24-25
requirements and request specifications 42-43
Skilled Nursing Facility (SNF) claims data 21
data destruction 139
data dictionaries 68n3
data distribution contractor 18
Data Entrepreneurs' Synthetic Public Use File (DE-SynPUF) 7, 27n4
Data Extract System (DESY) 18, 27n5, 40-41
data sets
loading claims and enrollment data into 46-47
size and efficiency of 104n7
transforming 47-51
data storage, planning 35-36
Data Use Agreement (DUA) 8n6, 44, 138
date of death variable 57, 68n4
DEATH_2010 variable 57, 58, 59
DEATH_DT variable 57
decrypting claims data 46
delimiting claims by continuously enrolled beneficiary population 72-73
DESY (Data Extract System) 18, 27n5, 40-41
diabetes
beneficiaries with 108-116
identifying 121n5
diabetic eye exams, for beneficiaries with diabetes 116-118
DIA_FLAG variable 113, 116, 130
Diagnosis Present on Admission (POA) indicator 23
displaying results
by age group 62-63
by coverage characteristics 59-61
by geographic characteristics 63-66
by month of death 59-61
by race 59-61
by sex 59-61
DME (durable medical equipment) 19-20, 72
DME file 71
DSCHRGT variable 89n3
DUA (Data Use Agreement) 8n6, 44, 138
durable medical equipment (DME) 19-20, 72
E
ED_SVC variable 80-81
electronic health records (EHRs) 2
eligibility 11, 15n2
E&M
See Evaluation and Management (E&M)
EM_COST variable 95
Emergency Department (ED) utilization
identification of 25
measuring 80-81
EM_SVC variable 74, 95, 115
EM_TOTBENE_PROV variable 128, 129
EM_TOTCOST_BENE variable 128
EM_TOTCOST_PROV variable 128
END2 variable 86
end-stage renal disease (ESRD) 10, 11, 68n2
enrolled FFS beneficiaries, identifying 55-59
enrollment, in Medicare 11
enrollment data
about 53-54
basics of 54-55
creating final data for remainder of programming 66
creating/retaining data elements for displaying results 59-66
decrypting 45-47
identifying enrolled FFS beneficiaries 55-59
loading 45-47
receiving 45-47
requesting 40-41
sources of 40-41
Evaluation and Management (E&M)
measuring payments 95-98
measuring utilization 73-74
visits for beneficiaries with Diabetes or COPD 114-116
evaluative studies 8n4
examples
identification of Emergency Department (ED) utilization 25
identification of surgical services 26
project 3-5
EYE_SVC variable 116, 135, 136
F
Federal Information Processing Standard (FIPs) coding system 68n7
Federal Insurance Contributions Act (FICA) taxes 10
FFS (Medicare Fee-for-Service) 11-12, 54
flowcharts
about 38n2
planning 33-35
FORMAT procedure 60, 62
framework, of this book 2-3
FREQ procedure 58, 61, 63, 77, 79, 115, 116, 130, 132, 133, 136
FROM_DT variable 51, 85-87, 89n7
G
geographic characteristics, displaying results by 63-66
H
HCPCS_CD1-HCPCS_CD13 variable 74
HCPCS-General Information (website) 28n14
Health Care Provider Taxonomy Code (HPTC) 24-25
health maintenance organizations (HMOs) 12
“health reform legislation” 11
Healthcare Common Procedure Coding System (HCPCS) codes 23, 89n1
HHAs (Home Health Agencies) 21, 71, 104n5
HHRGs (home health resource groups) 21
HI (Hospital Insurance) 11
HIC variable 22, 28n13
HICAN variable 22
HMO coverage variable 56
HMOs (health maintenance organizations) 12
Home Health Agencies (HHAs) 21, 71, 104n5
home health claims data 21
home health resource groups (HHRGs) 21
hospice claims data 22
hospice claims file 71
hospice service 10
Hospital Compare 89n4
Hospital Insurance (HI) 11
hospital readmissions, for beneficiaries with COPD 118-120
Hospital Referral Regions (HRRs) 63, 68n6
Hospital Service Areas (HSAs) 63, 68n6
“How to Identify Emergency Room Services in the Medicare Claims Data” 89n5
HPTC (Health Care Provider Taxonomy Code) 24-25
I
ICD-10 28n15
identifying
See also chronic conditions, identifying
beneficiaries with Diabetes or COPD 108-114
Emergency Department (ED) utilization 25
enrolled FFS beneficiaries 55-59
IDR (Integrated Data Repository) 18, 27n5, 40-41
Inpatient Prospective Payment System (IPPS) 75
inpatient psychiatric care 12
inpatients
measuring hospital payments 98-100
measuring hospitalization utilization 75-79
presenting length of stay information by state 131-133
Integrated Data Repository (IDR) 18, 27n5, 40-41
International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) 23
International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) 28n15
IP_ALOS variable 78, 132
IP_LOS variable 76, 132
IPPS (Medicare Inpatient Prospective Payment System) 75
IP_TOTCOST_BENE variable 98
J
Johnson, Lyndon 10
L
LDS (Limited Data Sets) 42
legislation
Affordable Care Act (2010) 11
Balanced Budget Act (1997) 10
Medicare Prescription Drug, Improvement, and Modernization Act (MMA) (2003) 10
libname CND 'C:DATA09_Conditions' 36
libname CST 'C:DATA08_Cost' 36
libname ENR 'C:DATA06_Enrollment' 36
libname ETL 'C:DATA05_ETL' 35-36
libname FNL 'C:DATA10_Results' 36
libname SRC 'C:DATA00_Source_Data' 35
libname UTL 'C:DATA07_Utilization' 36
LIBNAMES, planning 35-36
Limited Data Sets (LDS) 42
line level data sets, transforming into single claim-level files 47-48
LINE_ICD_DGNS_CD variable 49
line-level carrier data, transforming into claim-level files 48-51
line-level procedure codes 122n7
LINEPMT variables 95, 97
loading claims data 46-47
long-term care services 12
long-term disabilities 10
Lou Gehrig's disease (ALS) 10
M
MA (Medicare Advantage) 12
MA prescription drug plans (MA-PDPs) 12
Master Beneficiary Summary File (MBSF) 24, 28n16, 42, 55, 68n7
MEANS procedure 134-135
measuring
See also costs, to Medicare
See also utilization of services
Emergency Department (ED) utilization 80-81
Evaluation and Management (E&M) payments 95-98
Evaluation and Management (E&M) utilization 73-74
inpatient hospital payments 98-100
inpatient hospitalization utilization 75-79
outpatient visit information 84-85
total Part A Payments 100-102
utilization of ambulance services 81-84
utilization of SNF, Home Health Agency, and Hospice Care 85-87
mechanics, of Medicare 13-14
Medicaid 15n5
Medicare
See also costs, to Medicare
See also specific topics
about 1, 2, 9-11
beneficiary identifier 22-23
eligibility 11
enrollment 11
mechanics of 13-14
timeline for 15n3
what is covered 11-12
what is not covered 12-13
Medicare Administrative Contractor (MAC) 13, 19
Medicare Administrative data
See claims data
See data
See enrollment data
Medicare Advantage (MA) 12
'Medicare and Home Health Care' booklet 28n10
Medicare and You 15n7
Medicare Benefits 15n6
Medicare claims data
See claims data
'Medicare Coverage of Durable Medical Equipment and Other Devices' booklet 27n6
'Medicare Coverage of Skilled Nursing Facility Care' booklet 16n10, 27n9
Medicare data
See data
Medicare enrollment data
See enrollment data
Medicare Fee-for-Service (FFS) 11-12, 54
'Medicare Hospice Benefits' booklet 28n11
Medicare Inpatient Prospective Payment System (IPPS) 75
Medicare Part A 11, 54, 56, 70
Medicare Part B 11-12, 19, 54, 56, 70-71
Medicare Part C 2, 12, 54, 55
Medicare Part D 1, 12
Medicare payments for Evaluation and Management services by provider, presenting 127-129
Medicare Prescription Drug, Improvement, and Modernization Act (MMA) (2003) 10
Medicare Secondary Payer 68n2
Medicare Severity-Diagnosis Related Groups (MS-DRGs) 23, 75
Medicare+Choice program 10
medication 15n8
MedPAC 104n1
MedPAR file 27n8
Metropolitan Statistical Area (MSA) 63
Missouri Department of Health and Senior Services 121n1
mlogic 104n6
month of death, displaying results by 59-61
mprint 104n6
MSA (Metropolitan Statistical Area) 63
MSABEA file 68n8
MS-DRGs (Medicare Severity-Diagnosis Related Groups) 23, 75
N
National Plan and Provider Enumeration System (NPPES) 24-25, 28n17
National Provider Identifier (NPI) 23
“Negative Payment Amounts in the Medicare Claims Data” 104n4
nodupkey sort 68n9
Non-Identifiable Files 42
O
OP_VISIT_CNT variable 84
“original fee-for-service (FFS)” 11-12, 54
Outpatient Prospective Payment System (OPPS) 20
outpatients
claims data 20
measuring visit information 84-85
prescription drugs 10
output and project disposition
about 123-124
accomplishments 124
presenting inpatient length of stay information by state 131-133
presenting mean Medicare Part A payments per beneficiary by state and county 133-135
presenting rates of diabetic eye exams 135-137
presenting selected measurements of utilization, cost to Medicare, and quality of outcomes 125-131
production execution in batch 138
programming plan 124-125
project disposition 138-139
P
paperwork, completing 43-45
Part A 11, 54, 56, 70
Part B 11-12, 19, 54, 56, 70-71
Part C 2, 12, 54, 55
Part D 1, 12
PA_TOTCOST_BENE variable 134
payment standardization 94
PDPs (prescription drug plans) 12
physical screening 10
physical therapy 10
planning
about 29-30
data storage 35-36
flowchart 33-35
LIBNAMES 35-36
quality assurance (QA) plan 33
requirements 32
SDLC 30-32
technical specifications 36-37
PMT_AMT variable 76, 98, 100, 104n3, 109
POA (Diagnosis Present on Admission) indicator 23
PPS (Prospective Payment System) 2, 10, 14, 16n3, 92
preferred provider organizations (PPOs) 12
prescription drug plans (PDPs) 12
presenting
ambulance utilization 125-127
inpatient length of stay information by state 131-133
mean Medicare Part A payments per beneficiary by state and county 133-135
Medicare payments for Evaluation and Management services by provider 127-129
rates of diabetes and COPD 129-131
rates of diabetic eye exams 135-137
selected measurements of utilization, cost to Medicare, and quality of outcomes 125-131
preventive screening 10
PRFNPI variable 97
PRINT procedure 84, 129
Privacy Act (1974) 44
procedure codes 122n9
procedures
FORMAT 60, 62
FREQ 58, 61, 63, 77, 79, 115, 116, 130, 132, 133, 136
MEANS 134-135
PRINT 84, 129
SQL 52n5, 78, 84, 93, 95-97, 100, 119, 128
SUMMARY 126-127
production execution in batch 138
programming, in SAS to define continuous enrollment in Medicare FSS 57-59
project disposition
See output and project disposition
Prospective Payment System (PPS) 2, 10, 14, 16n13, 92
provider data 24-25
provider identifier 23
PROVIDER variable 75-76
PROVTYPE variable 76
Public Use Files (PUFs) 42
Q
quality assurance (QA) procedures 30, 33
R
race, displaying results by 59-61
RACE variable 59-61
rates of diabetes and COPD, presenting 129-131
rates of diabetic eye exams, presenting 135-137
receiving claims data 45-46
requesting data 40-41
requirements, for planning 32
Research Data Assistance Center (ResDAC) 16n12, 18, 28n18, 40-41, 43-45, 52n2, 68n4, 89n5, 89n7, 104n3
Research Data Distribution Center 18
Research Identifiable Files (RIFs) 42
retaining data elements for displaying results 59-66
risk adjustment 94
S
SDLC (Systems Development Life Cycle) 30-32
services, codes identifying 23
services, utilization of
about 69-70
basics of Medicare claims data 70-72
delimiting claims by continuously enrolled beneficiary population 72-73
measuring 81-84
measuring emergency department utilization 80-81
measuring E&M utilization 73-74
measuring inpatient hospitalization utilization 75-79
measuring outpatient visit information 84-85
measuring utilization of ambulance services 81-84
measuring utilization of SNF, Home Health Agency, and Hospice Care 85-87
programming plan 72
sex, displaying results by 59-61
SEX variable 59-61
Shannon, Doug 89n8
skilled nursing facilities (SNFs) 11, 21
SMI (Supplemental Medical Insurance) 11-12
SNF file 71
Social Security Disability Insurance (SSDI) 11
source data 18, 27n3, 40-41, 52n1, 52n3
specifying programming for continuous enrollment in Medicare FFS 56
speech therapy 10
SQL procedure 52n5, 78, 84, 93, 95-97, 100, 119, 128
SSA variable 64, 65
SSDI (Social Security Disability Insurance) 11
standardization, payment 94
STATE_CD variable 64
STAY_CNT variable 78
STUDY_AGE variable 62, 68n5, 125-126
substring 89n2
SUMMARY procedure 126-127
Supplemental Medical Insurance (SMI) 11-12
support, online, for this book 7
surgical services, identification of 26
Synthetic Public Use File (DE-SynPUF) 7, 27n4
Systems Development Life Cycle (SDLC) 30-32
T
technical specifications, planning 36-37
terminally ill individuals 10
THRU_DT variable 51, 51f, 85-87, 89n7
TOT_AMB variable 83-84
TOT_AMB_SVC variable 125-126
TOT_IP_LOS variable 78
transforming base claim and line level data sets 47-51
Truman, Harry 10
U
UB-92 form 20
University of Georgia listserv 122n10
UNIX 138
utilization of services
about 69-70
basics of Medicare claims data 70-72
delimiting claims by continuously enrolled beneficiary population 72-73
measuring 81-84
measuring emergency department utilization 80-81
measuring E&M utilization 73-74
measuring inpatient hospitalization utilization 75-79
measuring outpatient visit information 84-85
measuring utilization of ambulance services 81-84
measuring utilization of SNF, Home Health Agency, and Hospice Care 85-87
programming plan 72
utilization of SNF, Home Health Agency, and Hospice Care, measuring 85-87
V
VALSUG 89n8
variables
about 28n12
ADMSN_DT 89n3
AGE_CATS 62-63, 125-126
AMB_CARR_SVC 83-84
A_MO_CNT 56
BENE_HI_CVRAGE_TOT_MONS 56, 57
BENE_HMO_CVRAGE_TOT_MONS 56, 57
BENE_ID 22, 48, 49, 50, 51, 66, 71, 73, 78, 83, 86, 101-102, 116, 119, 125, 128
BENE_SMI_CVRAGE_TOT_MONS 56, 57
B_MO_CNT 56
CLAIM_SEGMENT 86-87
CLAIM_SEGMENT_ID 86
CLM_ID 48, 49, 50, 51
CLM_LN 48, 49
CNTY_CD 64
CONTENRL_AB_2010 57, 58, 59
CONTENRL_HMO_2010 57, 58, 59
COPD_CARR_SUM 111, 113
COPD_FLAG 113, 130
COPD_HH_SUM 111
COPD_IP_SUM 111
COPD_OP_SUM 111, 113
COPD_SN_SUM 111
date of death 57, 68n4
DEATH_2010 57, 58, 59
DEATH_DT 57
DIA_FLAG 113, 116, 130
DSCHRGT 89n3
ED_SVC 80-81
EM_COST 95
EM_SVC 74, 95, 115
EM_TOTBENE_PROV 128, 129
EM_TOTCOST_BENE 128
EM_TOTCOST_PROV 128
END2 86
enrollment 56
EYE_SVC 116, 135, 136
FROM_DT 51, 85-87, 89n7
HCPCS_CD1-HCPCS_CD13 74
HIC 22, 28n13
HICAN 22
HMO coverage 56
IP_ALOS 78, 132
IP_LOS 76, 132
IP_TOTCOST_BENE 98
LINE_ICD_DGNS_CD 49
LINEPMT 95, 97
OP_VISIT_CNT 84
PA_TOTCOST_BENE 134
PMT_AMT 76, 98, 100, 104n3, 109
PRFNPI 97
PROVIDER 75-76
PROVTYPE 76
RACE 59-61
SEX 59-61
SSA 64, 65
STATE_CD 64
STAY_CNT 78
STUDY_AGE 62, 68n5, 125-126
THRU_DT 51, 85-87, 89n7
TOT_AMB 83-84
TOT_AMB_SVC 125-126
TOT_IP_LOS 78
V_DOD_SW 57
V_DOD_SW variable 57
Virtual Research Data Center (VRDC) system 18, 40-41
voluntary prescription drug coverage 12
W
War on Poverty 10
Numerics
05_ETL.sas program 34, 35
06_Enrollment.sas program 35
07_Utilization.sas program 35
08_Cost.sas program 35
09_Conditions.sas program 35
10_Presenting_Output.sas program 35
837i electronic format 21