Medicare Provider Utilization & Payment Data

Mission Impossible Assignment for Plan Sponsors

Nothing is secret about health care costs although many third party intermediaries wish it so. Piecing all the data towards responsible stewardship of an employer sponsored health plan is not impossible. Reviewing managed care contracts is not impossible either. Once I was told I would never get my hands on a Blue Cross hospital contract. I did. – Bill Rusteberg

Medicare Provider Utilization and Payment Data: Physician and Other Supplier

The Physician and Other Supplier Public Use File (Physician and Other Supplier PUF) provides information on services and procedures provided to Medicare beneficiaries by physicians and other healthcare professionals. The Physician and Other Supplier PUF contains information on utilization, payment (allowed amount and Medicare payment), and submitted charges organized by National Provider Identifier (NPI), Healthcare Common Procedure Coding System (HCPCS) code, and place of service. This PUF is based on information from CMS administrative claims data for Medicare beneficiaries enrolled in the fee-for-service program. The data in the Physician and Other Supplier PUF covers calendar years 2012 through 2017 and contains 100% final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population.

While the Physician and Other Supplier PUF has a wealth of information on payment and utilization for Medicare Part B services, the dataset has a number of limitations. Of particular importance is the fact that the data may not be representative of a physician’s entire practice as it only includes information on Medicare fee-for-service beneficiaries. In addition, the data are not intended to indicate the quality of care provided and are not risk-adjusted to account for differences in underlying severity of disease of patient populations. For additional limitations, please review the methodology document available below.

Medicare Physician and Other Supplier Data CY 2017
Medicare Physician and Other Supplier Data CY 2016
Medicare Physician and Other Supplier Data CY 2015
Medicare Physician and Other Supplier Data CY 2014
Medicare Physician and Other Supplier Data CY 2013
Medicare Physician and Other Supplier Data CY 2012

Inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.

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