Skilled Nursing Facility (SNF) Claims Data
Commonly Retained Elements in Administrative Claims Data
Master Beneficiary Summary File
Provider Data
Example: Identification of Emergency Department (ED) Utilization
Example: Identification of Surgical Services
Chapter Summary
Chapter 4: Planning the Research Programming Project
Introduction and Goals of This Chapter
Our Project’s Plan: The SDLC
Our Project’s High-Level Requirements
Our Project’s Quality Assurance Plan
Our Project’s Flowchart
Our Project’s Data Storage and LIBNAMES
Our Research Programming Technical Specifications
Chapter Summary
Chapter 5: Request, Receive, Load, and Transform Data
Introduction
Requesting Medicare Administrative Claims and Enrollment Data
Sources of Medicare Claims and Enrollment Data
Data Available from CMS
Our Project’s Data Requirements and Request Specifications
Contacting ResDAC and Completing Paperwork
Receiving, Decrypting, and Loading Medicare Administrative Claims and Enrollment Data
Receiving Our Medicare Administrative Data
Decrypting Our Medicare Administrative Data
Loading Our Medicare Administrative Data into SAS Data Sets
Algorithms: Transforming Base Claim and Line Level Data Sets into Single Claim-Level Files
Transforming Base Claim and Line-Level Carrier Data into a Claim-Level File
Chapter Summary
Chapter 6: Working with Enrollment Data
Introduction and Goals
Review and Approach
Basics of Medicare Enrollment Data
Our Programming Plan
Algorithms: Identifying Continuously Enrolled FFS Beneficiaries
Why Define Continuously Enrolled FFS Beneficiaries?
How to Specify the Programming for Continuous Enrollment in Medicare FFS
Medicare Part A and Part B Enrollment Variables
HMO Coverage Variable
Date of Death Variable
How to Program in SAS to Define Continuous Enrollment in Medicare FFS
Algorithms: Create or Retain Data Elements for Displaying Results by Certain Characteristics
Coverage Characteristics, Month of Death, Sex, and Race
Age Groups
Geographic Characteristics
Algorithms: Create Final Enrollment Data for Remainder of Programming
Chapter Summary
Exercises
Chapter 7: Measuring Utilization of Services
Introduction and Goals
Review and Approach
Review: Basics of Medicare Claims Data
Our Programming Plan
Algorithms: Delimit Claims by Continuously Enrolled Beneficiary Population
Algorithms: Measuring Evaluation and Management (E&M) Utilization
Algorithms: Measuring Inpatient Hospital Utilization
Algorithms: Measuring Emergency Department Utilization
Algorithms: Measuring Utilization of Ambulance Services
Algorithms: Measuring Outpatient Visit Information
Algorithms: Measuring Utilization of SNF, Home Health Agency, and Hospice Care
Chapter Summary
Exercises
Chapter 8: Measuring Costs to Medicare
Introduction and Goals
Review and Approach
Review: Basics of Medicare Cost
Our Programming Plan
A Note on Payment Standardization and Risk Adjustment
Algorithms: Measuring Evaluation and Management Payments
Algorithms: Measuring Inpatient Hospital Payments
Algorithms: Measuring Total Part A Payments
