CMS publishes Medicare Fee-for-Service Provider & Supplier Lists
March 3, 2016 09:47 AM
In an effort to improve care delivery, data sharing, and transparency, the Centers for Medicare & Medicaid Services (CMS) is releasing two public data sets regarding the availability and use of services provided to Medicare beneficiaries by ground ambulance suppliers and home health agencies, as well as a list of Medicare fee-for-service (FFS) providers and suppliers currently approved to bill Medicare. The data sets are accessible here.
The Moratoria Provider Services and Utilization Data Tool includes interactive maps and a dataset that shows national-, state-, and county-level provider and supplier services and utilization data that can be used by CMS to determine which geographic and health service areas might be considered for a moratorium on new provider and supplier enrollments. The data provides the number of Medicare providers and suppliers servicing a geographic region, identifies moratoria regions at the state and county levels, and identifies the number of people with Medicare benefits who use a specific health service in that region. The data can also be used to reveal service levels related to the number of providers and suppliers in a geographic region. Utilization data and geographic regions for these services can be easily compared using interactive maps.
The Public Provider data allow users, including other health plans, to easily access and validate provider and supplier information against Medicare data. Public Provider Enrollment file sets include information on providers and suppliers, nationwide, who are approved to bill Medicare. The data is extracted directly from the Provider Enrollment, Chain and Ownership System (PECOS) and is updated quarterly.
The Moratoria Provider Services and Utilization Data Tool was created using ground ambulance and home health agency paid claims data that reside in CMS systems for Medicare FFS beneficiaries. The data in this release cover the period from October 1, 2014 to September 30, 2015 and will continue to be updated quarterly. Data are available for each of the 50 states, their counties, and the District of Columbia. The data set does not contain any individually identifiable information about Medicare beneficiaries.
The public provider data consist of individual and organizational provider and supplier enrollment information and includes names, National Provider Identifier and other unique identifiers, enrollment type, specialty, and limited address information (City, State, ZIP Code).
For more information on the recent temporary enrollment moratoria extension please see the Federal Register posting here.
To view the Ambulance and Home Health Agency data set and a related fact sheet, click here.
To view the Public Provider Enrollment data set and a related fact sheet, click here.