Moratoria Provider Services and Utilization at State and County Level

$716 / year

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.

Complexity

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.

Date Created

2014-10-01

Last Modified

2016-07-15

Version

2016-07-15

Update Frequency

Quarterly

Temporal Coverage

2014-10-01 to 2015-12-31

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare and Medicaid Services (Data.CMS.gov)

Source License URL

John Snow Labs Standard License

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

NameDescriptionTypeConstraints
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 renderedstringrequired : 1
CountyName of the County for which the services are renderedstringrequired : 1
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.integerrequired : 1 level : Ratio
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 servicenumberrequired : 1 level : 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
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
Reference_PeriodType_of_Service_ProvidedAggregation_LevelState_AbbreviationCountyNumber_of_Fee_for_Service_BeneficiariesNumber_of_ProvidersAverage_Number_of_Users_Per_ProviderPercentage_of_Users_Out_of_FFS_BeneficiariesAverage_Number_of_Providers_Per_CountyPercentage_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_County
2014-10-01 to 2015-09-30Home HealthCountyNEPolk12322100
2015-01-01 to 2015-12-31Home HealthCountyKSLogan6352100
2014-10-01 to 2015-09-30Home HealthCountyMNCook8791.5100
2014-10-01 to 2015-09-30Home HealthCountySDDay12571.6100
2015-01-01 to 2015-12-31Home HealthCountySDDay12341.8100
2014-10-01 to 2015-09-30Home HealthCountyIDCamas1836.6100
2014-10-01 to 2015-09-30Home HealthCountyKSKiowa5911.9100
2014-10-01 to 2015-09-30Home HealthCountyKSLogan6241.8100
2014-10-01 to 2015-09-30Home HealthCountySDDeuel7843.4100
2014-10-01 to 2015-09-30Home HealthCountyTXIrion3106.5100