A
A/B MAC Jurisdictions
Medicare's claims processing operations have realized significant operational savings
from the consolidation of state workloads and the efficiencies gained through integrating
Part A and Part B functionality.
The Alignment Initiative
The goal is to more effectively integrate the Medicare and Medicaid programs. Partnering with States, health care providers,
caregivers and beneficiaries, CMS will work to improve quality, reduce costs and improve the dual eligible beneficiary experience.
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B
Basic Stand Alone (BSA) Medicare Public Use Files (PUFs)
Medicare claims data of 2008 5% sample PUF for a variety of Medicare claim types.
The claim types are Inpatient, Durable Medical Equipment (DME) Line Items, Prescription
Drug Events (PDE), Hospice Beneficiary, Carrier Line Items, Home Health Agency (HHA),
Outpatient Procedures and Skilled Nursing Facility (SNF) Beneficiary.
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C
CMS Dashboards
Information on Medicare Inpatient Hospital and Medicare Prescription Drug Benefit
Dashboard BETA.
CMS Form CMS 2567
Statement of Deficiencies and Plan of Correction for Nursing Homes.
Congressional Budget Office
Provides objective analyses on economic and budgetary decisions on the programs
covered by the federal budget for the Congressional budget process.
Contract Enforcement Actions
Provides data on sanctions levied against Medicare Advantage and PDP sponsors for
violations of CMS requirements since January 2006.
Cost Reports
These reports reflect data as reported to the Healthcare Cost Report Information
System (HCRIS) by Medicare Fiscal Intermediaries.
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D
Data.gov Catalogs
Public access to machine readable datasets generated by the Executive Branch of
the Federal Government. Use the Data.gov catalog link to easily download and use
CMS datasets.
Data.Medicare.Gov
Used primarily by health policy researchers and the media to access data in an interactive
format.
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E
Electronic Health Records (EHR) Incentive Programs
The Medicare and Medicaid EHR Incentive Programs will provide incentive payments to eligible professionals,
eligible hospitals and critical access hospitals (CAHs) as they adopt, implement, upgrade or demonstrate meaningful
use of certified EHR technology.
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F
Federal Digital System (FDsys)
Replaced GPO Access as the official online repository of government laws, regulations,
court decisions and Congressional deliberations.
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G
There is no information starting with the letter G.
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H
Health Care Information
System (HCIS)
Contains Medicare Part A (Inpatient, Skilled Nursing Facility, Home Health Agency
and Hospice) & Medicare Part B (Outpatient) based on the type and state of the
institutional provider.
HealthCare.gov
Designed to help all Americans, not just those covered by Medicare or Medicaid,
get the information they need to make the best choices about their health care (Insurance
Options Finder, Health Finder & consumer rights).
HHS Electronic FOIA Reading Room
Contains HHS material, including final opinions, Departmental Appeals Board decisions,
policy statements, administrative manuals, and frequently requested records.
HHS Information Resources Directory
Browse an alphabetical list of hundreds of HHS resources organized by topic (e.g.,
abuse, aging, civil rights, etc.) and find a link to web sites at HHS with information
on those topics.
HHS Information Resources Guide
Read online information, learn how to request information, and find operating divisions'
and program offices' publications contacts at this Guide to HHS Information Resources
organized by HHS agency.
HHS Open Government
Engage with HHS as it makes its operations more transparent to the public. Collaborate
on data sets, tools and HHS initiatives to help us serve the public more effectively.
Hospital Outpatient PPS
Calendar year files that contain payment amounts and supporting files for services
paid under the OPPS.
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I
ICD-10
Find resources and ICD-10 and Version 5010 Implementation Timelines to help, Payer Resources and Vendor Resources
with the U.S. health care industry's upgrade to Version 5010 and transition to ICD-10.
Identifiable Data Files
Identifiable Data Files contain actual beneficiary-specific and physician-specific
information. Identifiable Files require a formal request to be submitted to CMS
for approval.
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J
There is no information starting with the letter J.
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K
There is no information starting with the letter K.
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L
Limited Data Sets
Files that contain beneficiary level health information but exclude specified direct
identifiers as outlined in the Health Insurance Portability and Accountability Act
(HIPAA Privacy Rule).
Limited Income Resources
Information for those with limited income and resources (those who may qualify for or already have the Low
Income Subsidy to lower their prescription drug coverage costs.
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M
MDS 2.0 Public Reports
Minimum Data Set (MDS) is part of the federally mandated process for clinical assessment of all residents in Medicare or
Medicaid certified nursing homes.
Medicaid Managed Care Enrollment Report
Profiles enrollment statistics on Medicaid managed care programs on a plan-specific level. The managed care enrollment
statistics include enrollees receiving comprehensive benefits and limited benefits and are point-in-time counts.
Medicaid State Waivers and Program
Demonstrations
The Social Security Act authorizes multiple waiver and demonstration authorities
to allow states flexibility in operating Medicaid programs. Access what kinds of
waivers and demonstrations have been proposed and/or approved in your state.
Medicaid Statistical Information System (MSIS) Drug Summary Mart
Provides background needed to take advantage of the capabilities of the MSIS Drug Summary Data mart. This mart allows the user
to develop high level Medicaid utilization statistics for selected groups of drugs covering a range of Medicaid program
statistics using a simple drag-and-drop table building tool.
Medicaid Statistical Information System (MSIS) State Summary Mart
Provides background needed to take advantage of the capabilities of the MSIS State Summary Data mart. This mart allows
the user to develop high-level statistical tables covering a range of Medicaid program statistics using a simple drag-and-drop
table building tool.
Medicare Ambulance Fee Schedule
Provides calendar year files that contain the payment amounts used to pay for services
provided by ambulance providers and suppliers.
Medicare Clinical Lab Fee Schedule
Provides calendar year files that contain the payment amounts used to pay for lab
services paid under the Medicare Clinical Lab Fee Schedule.
Medicare Contracting Reform
CMS will ensure that Medicare claims continue to be processed effectively, accurately
and in a timely manner and contracts will be subject to the Federal Acquisition
Regulation.
Medicare Coverage
Database
Contains all National Coverage Determinations (NCDs) and Local Coverage Determinations
(LCDs), local articles, and proposed NCD decisions. The database also includes National
Coverage policy related documents, including National Coverage Analyses (NCAs),
Coding Analyses for Labs (CALs), Medicare Evidence Development & Coverage Advisory
Committee (MEDCAC) proceedings, and Medicare coverage guidance documents.
Medicare Managed Care Appeals & Grievances
Medicare health plans, which include Medicare Advantage (MA) plans – such as Health Maintenance Organizations, Preferred
Provider Organizations, Medical Savings Account plans and Private Fee-For-Service plans – Cost Plans and Health Care
Prepayment Plans, must meet the requirements for grievance and appeals processing under Subpart M of the Medicare
Advantage regulations.
Medicare Ombudsman
Working to ensure people with Medicare get the information and help they need to
understand their Medicare options, and to apply their rights and protections.
Medicare Part B Drugs
Quarterly files contain the payment amounts used to pay for Medicare Part B covered
drugs.
Medicare Plan Finder
Compare options for joining health and drug plans under the Medicare program, including
Medicare Advantage and Medicare Prescription Drug plans.
Medicare Shared Savings Program
Facilitates coordination and cooperation among providers to improve the quality
of care for Medicare fee-for-service beneficiaries and reduce unnecessary costs.
Medicare Supplier Directory
Provides names, addresses and contact information for suppliers that provide services or products under the Medicare program.
MyMedicare.gov
For specific questions about your claims, records, or expenses, visit, or call 1-800-MEDICARE.
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N
Nursing Home Compare
Find nursing homes in your area. This tool has detailed information about every
Medicare and Medicaid-certified nursing home in the country.
Nursing Home Providers
This dataset has detailed information about every Medicare and Medicaid-certified nursing home in the country. It also
has Chain providers information (Multi-nursing home chains have two or more homes under one ownership or operation).
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O
Office for Civil Rights (OCR) - How To File a Complaint
If you believe that you have been discriminated against because of your race, color, national origin, disability,
age, sex or religion by a health care or human services provider (such as a hospital, nursing home, social service
agency) or by a State or local government health or human services agency, you may file a complaint with the Office
for Civil Rights (OCR).
Outcome and Assessment Information Set (OASIS) – C Reports
Medicare-certified home health agencies are required to use a standard set of data items, known as OASIS (Outcome and Assessment
Information Set) as part of a comprehensive assessment for all patients who are receiving skilled care that is reimbursed by
Medicare or Medicaid.
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P
Personal Computer (PC) Pricer
Tool used to estimate Medicare Prospective Payment System (PPS) payments for ESRD,
Inpatient Hospital, SNF, Home Health, IRF, IPF, LTCH, and Outpatient.
Physician Fee Schedule (PFS)
Includes PFS National Payment files, Physician Fee Schedule Relative Value Unit
(RVU) files and PFS Carrier Specific files.
Physician Self Referral
Section 1877 of the Social Security Act (the Act) (42 U.S.C. 1395nn), also known as the physician self-referral law and
commonly referred to as the “Stark Law”.
Provider Reimbursement Review Board (PRRB) Decisions
The PRRB is an independent panel to which a Medicare provider of services may appeal
if it is dissatisfied with a final determination of its fiscal intermediary or the
Centers for Medicaid & Medicare Services (CMS).
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Q
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R
Recovery Audit Program –Recent
Updates
Quarterly Recovery Audit Activity including Demanded and Corrected Amounts by Contractor,
Number of Additional Documentation Requests and Top Issues and Problems identified
by CMS.
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S
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T
There is no information starting with the letter T.
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U
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V
There is no information starting with the letter V.
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W
There is no information starting with the letter W.
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X
There is no information starting with the letter X.
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Y
There is no information starting with the letter Y.
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Z
There is no information starting with the letter Z.
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