Medicare Claims and Utilization

**Overview**
This data package contains Medicare spending statistics for beneficiaries grouped according to their age, gender, race/ethnicity and geographical location. At the same time, it provides data about spendings taking into consideration provider specific coordinates like the Hospital Referral Region (HRR) or Hospital Service Area (HSA). The data package contains as well as spending statistics based on the payment system, like the Outpatient Prospective Payment System.

**Description**
This data package is mainly based on the public data provided by the Centers for Medicare and Medicaid Services (CMS). It contains also statistics made available by The Dartmouth Atlas of Health Care. It provides access to spending data:
- by age, gender and race/ethnicity and state/HRR/HRA, based on claims or on the Continuous Medicare History Sample (CMHS)
- by price adjustment and age, gender and race/ethnicity and state/HRR/HRA
- by type of claim
- under Outpatient Prospective Payment System for Ambulatory Payment Classification (APC) Groups
In this data package additional data related to providers like clinic group practice reassignments or the Therapy Provider Phase.

**Benefits**
- Useful to researchers and analysts who seek to compare, understand and find useful information about the costs variations by beneficiaries demographics and localization.
- useful to public health specialists and specialized institutions to evaluate the type of beneficiaries groups. the fields descriptions along with the dataset description are again useful for the user to quickly understand the data and the dataset.

**License Information**
The use of John Snow Labs datasets is free for personal and research purposes. For commercial use please subscribe to the [Data Library](https://www.johnsnowlabs.com/marketplace/) on John Snow Labs website. The subscription will allow you to use all John Snow Labs datasets and data packages for commercial purposes.

**Included Datasets**
- [Clinic Group Practice Reassignment](https://www.johnsnowlabs.com/marketplace/clinic-group-practice-reassignment)
- This dataset shows the clinic group practice reassignment. Providers and suppliers must apply for enrollment in the Medicare program or make a change in their enrollment information using either the Internet-based Provider Enrollment Chain and Ownership System or the paper enrollment application process.
- [Hospital Service Area File 2017](https://www.johnsnowlabs.com/marketplace/hospital-service-area-file-2017)
- This dataset contains summarized information of Hospital Service Area (HHA) file by provider number and ZIP code of the Medicare beneficiary.
- [Hospital Service Area File 2018](https://www.johnsnowlabs.com/marketplace/hospital-service-area-file-2018)
- This dataset contains summarized information of Hospital Service Area (HHA) file by provider number and ZIP code of the Medicare beneficiary.
- [Hospital Service Area File 2019](https://www.johnsnowlabs.com/marketplace/hospital-service-area-file-2019)
- This dataset contains summarized information of Hospital Service Area (HHA) file by provider number and ZIP code of the Medicare beneficiary.
- [Hospital Service Area File 2020](https://www.johnsnowlabs.com/marketplace/hospital-service-area-file-2020)
- This dataset contains summarized information of Hospital Service Area (HHA) file by provider number and ZIP code of the Medicare beneficiary.
- [Hospital Service Area File 2021](https://www.johnsnowlabs.com/marketplace/hospital-service-area-file-2021)
- This dataset contains summarized information of Hospital Service Area (HHA) file by provider number and ZIP code of the Medicare beneficiary.
- [Medical Review on Therapy Provider Phase Information Claims](https://www.johnsnowlabs.com/marketplace/medical-review-on-therapy-provider-phase-information-claims)
- The Therapy Provider Phase Information dataset is a tool for providers to search for their National Provider Identifier (NPI) number to determine their phase for manual medical review of therapy claims.
- [Medicare Hospital Spending by Claim](https://www.johnsnowlabs.com/marketplace/medicare-hospital-spending-by-claim)
- This dataset includes a list of all hospitals that have been registered with Medicare and their Medicare Spending per Beneficiary (MSPB). The list includes Hospital Name, Period of hospital admission and Claim Type. It also includes Averages as well as Percentages of Spending per Episode for Hospital, State and Nation.
- [Medicare Spending CMHS Based by Age Sex and Race HRR Level](https://www.johnsnowlabs.com/marketplace/medicare-spending-cmhs-based-by-age-sex-and-race-hrr-level)
- This dataset includes the Hospital Refferal Region (HRR) level Medicare spending CMHS based data by age, sex and race. The HRRs represent regional healthcare markets for tertiary medical care that generally requires the services of a major referral center. The regions were defined by determining where patients were referred for major cardiovascular surgical procedures and for neurosurgery.
- [Medicare Spending CMHS Based by Age Sex and Race HSA Level](https://www.johnsnowlabs.com/marketplace/medicare-spending-cmhs-based-by-age-sex-and-race-hsa-level)
- This dataset includes the Hospital Service Area (HSA) level Medicare spending CMHS based data by age, sex and race. Hospital service areas (HSAs) are local healthcare markets for hospital care. An HSA is a collection of ZIP codes whose residents receive most of their hospitalizations from the hospitals in that area. HSAs were defined by assigning ZIP codes to the hospital area where the greatest proportion of their Medicare residents were hospitalized.
- [Medicare Spending CMHS Based by Age Sex and Race State Level](https://www.johnsnowlabs.com/marketplace/medicare-spending-cmhs-based-by-age-sex-and-race-state-level)
- This dataset includes the State level Medicare spending claims based data by price, age, sex and race. This dataset includes the county level Medicare spending claims based data by price, age, sex and race.
- [Medicare Spending Claims Based by Price Age Sex and Race County Level](https://www.johnsnowlabs.com/marketplace/medicare-spending-claims-based-by-price-age-sex-and-race-county-level)
- This dataset includes the county level Medicare spending claims based data by price, age, sex and race. The variables included are: state, number of Medicare enrollees, total Medicare reimbursements per enrollee, hospital and skilled nursing facility reimbursements per enrollee, physician reimbursements per enrollee, outpatient facility reimbursements per enrollee, home health agency reimbursements per enrollee, hospice reimbursements per enrollee, and durable medical equipment per enrollee.
- [Medicare Spending Claims Based by Price Age Sex and Race HRR Level](https://www.johnsnowlabs.com/marketplace/medicare-spending-claims-based-by-price-age-sex-and-race-hrr-level)
- This dataset includes the Hospital Referal Region (HRR) level Medicare spending claims based data by price, age, sex and race. Hospital referral regions (HRRs) represent regional healthcare markets for tertiary medical care that generally requires the services of a major referral center. The regions were defined by determining where patients were referred for major cardiovascular surgical procedures and for neurosurgery.
- [Medicare Spending Claims Based by Price Age Sex and Race HSA Level](https://www.johnsnowlabs.com/marketplace/medicare-spending-claims-based-by-price-age-sex-and-race-hsa-level)
- This dataset includes the Hospital Service Areas (HSA) level Medicare spending claims based data by price, age, sex and race. Hospital service areas (HSAs) are local healthcare markets for hospital care. An HSA is a collection of ZIP codes whose residents receive most of their hospitalizations from the hospitals in that area. HSAs were defined by assigning ZIP codes to the hospital area where the greatest proportion of their Medicare residents were hospitalized.
- [Medicare Spending Claims Based by Price Age Sex and Race State Level](https://www.johnsnowlabs.com/marketplace/medicare-spending-claims-based-by-price-age-sex-and-race-state-level)
- This dataset includes the State level Medicare spending claims based data by price, age, sex and race. The variables included are: state, number of Medicare enrollees, total Medicare reimbursements per enrollee, hospital and skilled nursing facility reimbursements per enrollee, physician reimbursements per enrollee, outpatient facility reimbursements per enrollee, home health agency reimbursements per enrollee, hospice reimbursements per enrollee, and durable medical equipment per enrollee.
- [Provider Summary of Outpatient Prospective Payment System APC 2011](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2011)
- This dataset contains estimated hospital specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2011. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
- [Provider Summary of Outpatient Prospective Payment System APC 2012](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2012)
- This dataset contains estimated hospital specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2012. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
- [Provider Summary of Outpatient Prospective Payment System APC 2013](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2013)
- This dataset contains estimated hospital specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2013. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
- [Provider Summary of Outpatient Prospective Payment System APC 2014](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2014)
- This dataset contains estimated hospital specific charges for 32 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2014. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
- [Provider Summary of Outpatient Prospective Payment System APC 2015](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2015)
- This dataset contains estimated hospital specific charges for 25 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2015. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
- [Provider Summary of Outpatient Prospective Payment System APC 2016](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2016)
- This dataset contains estimated hospital specific charges for 35 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2016. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
- [Provider Summary of Outpatient Prospective Payment System APC 2017](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2017)
- This dataset contains estimated hospital specific charges for 60 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2017. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.
- [Provider Summary of Outpatient Prospective Payment System APC 2018](https://www.johnsnowlabs.com/marketplace/provider-summary-of-outpatient-prospective-payment-system-apc-2018)
- This dataset contains estimated hospital specific charges for 60 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS) for Calendar Year (CY) 2018. The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount.

**Data Engineering Overview**
**We deliver high-quality data**
- Each dataset goes through 3 levels of quality review
- 2 Manual reviews are done by domain experts
- Then, an automated set of 60+ validations enforces every datum matches metadata & defined constraints
- Data is normalized into one unified type system
- All dates, unites, codes, currencies look the same
- All null values are normalized to the same value
- All dataset and field names are SQL and Hive compliant
- Data and Metadata
- Data is available in both CSV and Apache Parquet format, optimized for high read performance on distributed Hadoop, Spark & MPP clusters
- Metadata is provided in the open Frictionless Data standard, and its every field is normalized & validated
- Data Updates
- Data updates support replace-on-update: outdated foreign keys are deprecated, not deleted

**Our data is curated and enriched by domain experts**

Each dataset is manually curated by our team of doctors, pharmacists, public health & medical billing experts:
- Field names, descriptions, and normalized values are chosen by people who actually understand their meaning
- Healthcare & life science experts add categories, search keywords, descriptions and more to each dataset
- Both manual and automated data enrichment supported for clinical codes, providers, drugs, and geo-locations
- The data is always kept up to date – even when the source requires manual effort to get updates
- Support for data subscribers is provided directly by the domain experts who curated the data sets
- Every data source’s license is manually verified to allow for royalty-free commercial use and redistribution.

**Need Help?**
If you have questions about our products, contact us at [[e-mail]](mailto:[e-mail]).