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_PeriodRefers to the time period for which the claims have been analyzedstringrequired : 1
Type_of_Service_ProvidedType 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,stringrequired : 1
Aggregation_LevelThe geographic level at which the data has been collectedstringrequired : 1
State_AbbreviationAbbreviation of the state for which the services are rendered.stringrequired : 1
State_FIPS_CodeFIPS (Federal Information Processing Standards) of the state.integer-
CountyName of the County for which the services are renderedstring-
County_FIPS_CodeFIPS (Federal Information Processing Standards) of the state.integer-
Number_of_Fee_for_Service_BeneficiariesA 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.integerlevel : Ratiorequired : 1
Number_of_ProvidersClaims 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.integerlevel : 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 providernumberlevel : Ratio
Percentage_of_Users_Out_of_FFS_BeneficiariesThe proportion of Fee-For-Service beneficiaries who have a paid claim for a servicenumberlevel : Ratiorequired : 1
Number_OF_UsersIndicates the number of users.integerlevel : Ratio
Average_Number_of_Providers_Per_CountyFor 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.numberlevel : Ratio
Number_Of_Dual_Eligible_UsersDual 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).integerlevel : Ratio
Percentage_Of_Dual_Eligible_Users_Out_Of_Total_UsersThe proportion of dual eligible users divided by the total number of users.numberlevel : Ratio
Percentage_Of_Dual_Eligible_Users_Out_Of_FFS_BeneficiariesThe proportion of dual eligible users divided by dual eligible fee for service beneficiaries.numberlevel : Ratio
Total_PaymentFor 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.integerlevel : Ratio
Percentage_FFS_Beneficiaries_By_0_to_2_Providers_Serving_CountyPercentage of the Fee-for-Service beneficiaries which are served by 0 to 2 providers in that specific countynumberlevel : Ratio
Percentage_FFS_Beneficiaries_By_3_to_4_Providers_Serving_CountyPercentage of the Fee-for-Service beneficiaries which are served by 3 to 4 providers in that specific countynumberlevel : Ratio
Percentage_FFS_Beneficiaries_By_5_to_9_Providers_Serving_CountyPercentage of the Fee-for-Service beneficiaries which are served by 5 to 9 providers in that specific countynumberlevel : Ratio
Percentage_FFS_Beneficiaries_By_10_to_19_Providers_Serving_CountyPercentage of the Fee-for-Service beneficiaries which are served by 10 to 19 providers in that specific countynumberlevel : Ratio
Percentage_FFS_Beneficiaries_By_More_Than_20_Providers_Serving_CountyPercentage of the Fee-for-Service beneficiaries which are served by more than 20 providers in that specific countynumberlevel : Ratio
Number_Of_Fee_For_Service_Beneficiaries_Percentage_ChangeChange in percentage for number of fee for service beneficiaries.numberlevel : Ratio
Number_Of_Providers_Percentage_ChangeChange in percentage in average number of users per provider.numberlevel : Ratio
Average_Number_Of_Users_Per_Provider_Percentage_ChangeChange in percentage for average number of users per provider.numberlevel : Ratio
Percentage_Of_Users_Out_Of_FFS_Beneficiaries_Percentage_ChangeChange in percentage of users out of FFS Beneficiaries.numberlevel : Ratio
Number_Of_Users_Percentage_ChangeChange in percentage of number of users.numberlevel : Ratio
Average_Number_Of_Providers_Per_County_Percentage_ChangeChange in percentage of average number of providers per county.numberlevel : Ratio
Number_Of_Dual_Eligible_Users_Percentage_ChangeChange of percentage in number of dual eligible users.numberlevel : Ratio
Percentage_Of_Dual_Eligible_Users_Out_Of_Total_Users_Percentage_ChangeChange of percentage in percentage of dual eligible users out of total users.numberlevel : Ratio
Perc_Of_Dual_Eligi_Users_Out_Of_Dual_Elig_FFS_Benefi_Perc_ChangeChange of percentage in percentage of dual eligible FFS beneficiaries.numberlevel : Ratio
Total_Payments_Percentage_ChangeChange of percentage in total payments.numberlevel : Ratio

Data Preview

Reference PeriodType of Service ProvidedAggregation LevelState AbbreviationState FIPS CodeCountyCounty FIPS CodeNumber of Fee for Service BeneficiariesNumber of ProvidersAverage Number of Users Per ProviderPercentage of Users Out of FFS BeneficiariesNumber OF UsersAverage Number of Providers Per CountyNumber Of Dual Eligible UsersPercentage Of Dual Eligible Users Out Of Total UsersPercentage Of Dual Eligible Users Out Of FFS BeneficiariesTotal PaymentPercentage FFS Beneficiaries By 0 to 2 Providers Serving CountyPercentage FFS Beneficiaries By 3 to 4 Providers Serving CountyPercentage FFS Beneficiaries By 5 to 9 Providers Serving CountyPercentage FFS Beneficiaries By 10 to 19 Providers Serving CountyPercentage FFS Beneficiaries By More Than 20 Providers Serving CountyNumber Of Fee For Service Beneficiaries Percentage ChangeNumber Of Providers Percentage ChangeAverage Number Of Users Per Provider Percentage ChangePercentage Of Users Out Of FFS Beneficiaries Percentage ChangeNumber Of Users Percentage ChangeAverage Number Of Providers Per County Percentage ChangeNumber Of Dual Eligible Users Percentage ChangePercentage Of Dual Eligible Users Out Of Total Users Percentage ChangePerc Of Dual Eligi Users Out Of Dual Elig FFS Benefi Perc ChangeTotal Payments Percentage Change
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)NATION + TERRITORIES--ALL--420014189077517114696934421345354004259554726351522550000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATEAL1.0795482152630129576013291750093481341033452100000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATEAK2.089119302398716452237005481429173252000000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATEAZ4.07857051504679700495211160004842124001121770000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATEAR5.05252599459711561058189650048566534427412800000000
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATECA6.0382141035011061038704783160625003821531970149860000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATECO8.055956613034584479515102990033373143782415460000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATECT9.052056118342215772315431765007581995700001000000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATEDE10.0177218942411322681524380002093153400001000000000.00.00.00
2014-10-01 to 2015-09-30Ambulance (Emergency & Non-Emergency)STATEDC11.08452824436121045524481900801564900001000000000.00.00.00