The Medicare Current Beneficiary Survey (MCBS) public use file (MCBS PUF) provides the first publically available MCBS file for researchers interested in the health, health care use, access to and satisfaction with care for Medicare beneficiaries...
If a Part D plan sponsor issues an adverse redetermination decision, the enrollee or the enrollees representative may appeal the decision to the Independent Review Entity (IRE), also commonly called the Part D Qualified Independent Contractor (...
If, upon reconsideration, a Medicare Advantage (Part C) health plan upholds its initial adverse organization determination, the plan must submit the case file and its decision for automatic review by the Part C Independent Review Entity (IRE).
A redetermination is an examination of a claim by the fiscal intermediary (FI), carrier, or Medicare Administrative Contractor (MAC) personnel who are different from the personnel who made the initial claim determination. Appeals Fact Sheets.
This page presents Public Use Files and other publicly-available data on CMS End-Stage Renal Disease Program. The focus is on the congressionally mandated Program Management and Medical Information System.
The End Stage Renal Disease (ESRD) Quality Initiative promotes ongoing CMS strategies to improve the quality of care provided to ESRD patients. This initiative supports quality improvement efforts among providers and makes available quality...
Section 6001 of the Affordable Care Act of 2010 amended section 1877 of the Social Security Act to impose additional requirements for physician-owned hospitals to qualify for the whole hospital and rural provider exceptions. A physician-owned...
This page contains several useful trend and competition indicators. Certain files will be updated monthly while others will be updated quarterly. The files are the 13 Month Trend Report, Trends by State by Quarter Report, Competition Macro by...
Medicare fee-for-service data for each county broken out by aged, disabled, and ESRD beneficiaries including data on total Medicare fee-for-service reimbursement and enrollment for Parts A and B, the corresponding per capita reimbursement, for...
Medicare fee-for-service data for each county broken out by aged, disabled, and ESRD beneficiaries including data on total Medicare fee-for-service reimbursement and enrollment for Parts A and B, the corresponding per capita reimbursement, for...