DME Supplier Hospital and Practitioner Services Report Codes

**Overview**
This data package includes information about Medical Equipment Supplier Services for Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes. It also comprises of datasets about Medically Unlikely Edits (MUEs) Outpatient Hospital Services as well as Medically Edits Practitioner Services HCPCS / CPT codes.

**Description**
This data package contains the Medically Unlikely Edits (MUEs) which are defined for many Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes, the maximum allowable number of units of service by the same provider, for the same beneficiary, the same date of service, on the same claim line. Reported units of service greater than the MUE value are unlikely to be correct. MUE is a US Medicare unit of service claim edit applied to Medical claims against a procedure code for medical services rendered by one provider/supplier to one patient on one day. Claim edits compare different values on the medical claim to a set of defined criteria to check for irregularities, often in an automated claims processing system. The MUEs Outpatient Hospital Services which are designed to limit fraud and/or coding errors. They represent an upper limit that unquestionably requires further documentation to support. The ideal MUE is the maximum unit of service for a code on the majority of medical claims. MUE is part of the National Correct Coding Initiative (NCCI) to address coding methodologies. The MUEs Practitioner Services are also a part of this data package. The edits were developed based on anatomic considerations, HCPCS/CPT code descriptors, CPT instructions, Centers for Medicare and Medicaid Services (CMS) policies, nature of service/procedure, nature of the analyte, nature of the equipment, and clinical judgment. Prior to implementation, all edits were reviewed by national healthcare organizations, and their alternative recommendations were taken into consideration.

**Benefits**
- Useful for medical health planners, policymakers and medical research groups and medical students. dme supplier hospital and practitioner services report codes database is available on centers for medicare and medicaid services website in raw form, whereas a john snow labs (jsl) customer gets it in a clean and normalized form ready to use and create his own custom reports.
- easy to comprehend for the customers who are unfamiliar with the medical terminologies as all abbreviated terms are replaced with full form, unlike centers for medicare & medicaid services (cms) original datasets which are full of abbreviations.
- recent datasets for 2018 is available for use.

**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**
- [Medically Unlikely Edits Durable Medical Equipment Supplier Services](https://www.johnsnowlabs.com/marketplace/medically-unlikely-edits-durable-medical-equipment-supplier-services)
- This dataset showcases the Medically Unlikely Edits (MUEs) for Durable Medical Equipment Supplier Services as defined for many Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes, the maximum allowable number of units of service by the same provider, for the same beneficiary, the same date of service, on the same claim line. Reported units of service greater than the MUE value are unlikely to be correct.
- [Medically Unlikely Edits Outpatient Hospital Services](https://www.johnsnowlabs.com/marketplace/medically-unlikely-edits-outpatient-hospital-services)
- This dataset showcases the Medically Unlikely Edits (MUEs) for outpatient hospital services as defined for many Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes, the maximum allowable number of units of service by the same provider, for the same beneficiary, the same date of service, on the same claim line. Reported units of service greater than the MUE value are unlikely to be correct.
- [Medically Unlikely Edits Practitioner Services](https://www.johnsnowlabs.com/marketplace/medically-unlikely-edits-practitioner-services)
- This dataset showcases the Medically Unlikely Edits (MUEs) for Practitioner Services as defined for many Healthcare Common Procedure Coding System (HCPCS) / Current Procedural Terminology (CPT) codes, the maximum allowable number of units of service by the same provider, for the same beneficiary, the same date of service, on the same claim line. Reported units of service greater than the MUE value are unlikely to be correct.
- [Physician Supplier Procedure Summary 2018](https://www.johnsnowlabs.com/marketplace/physician-supplier-procedure-summary-2018)
- The Physician/Supplier Procedure Summary (PSPS) dataset is a summary of the calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The dataset is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service.
- [Physician Supplier Procedure Summary 2019](https://www.johnsnowlabs.com/marketplace/physician-supplier-procedure-summary-2019)
- The Physician/Supplier Procedure Summary (PSPS) dataset is a summary of the calendar year Medicare Part B carrier and durable medical equipment fee-for-service claims. The dataset is organized by carrier, pricing locality, Healthcare Common Procedure Coding System (HCPCS) code, HCPCS modifier, provider specialty, type of service, and place of service.

**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]).

搜集汇总

背景与挑战

背景概述

该数据集包含医疗设备供应商、门诊医院和执业医师服务的医疗不可能编辑（MUEs）数据，以及2018-2019年医疗保险B部分的医师/供应商程序摘要。这些数据经过清洗和标准化，适用于医疗健康规划、政策研究和学术用途。