CMS Releases Expanded Medicare Fee-for-Service Data

Monitoring tool can help fight fraud, safeguard taxpayer dollars, and protect beneficiaries.

The Centers for Medicare and Medicaid Services (CMS) recently released 2 sets of data on Medicare fee-for-service (FFS) suppliers and the use and availability of services provided.

A Federal Register notice was published extending the temporary enrollment moratoria on ambulance suppliers and home health agencies sub-units, as well as Medicare, Medicaid, and Children’s Health Insurance Programs (CHIP) branch locations for 6 more months in 7 different areas.

This extension was authorized by the Affordable Care Act and was made to decrease waste, abuse and fraud without any interruptions in the access to health care.

“CMS has used this powerful monitoring tool several times before to fight fraud, safeguard taxpayer dollars, and protect beneficiaries,” said CMS Deputy Administrator and Center for Program Integrity Director Shantanu Agrawal, MD. “By introducing data mapping for these specific, high-risk providers and suppliers in the moratoria areas and, for the first time, making service area data on all other FFS providers and suppliers publicly available, analyses of the data offers additional insight for CMS and its stakeholders.”

Any future data releases could include information on health care services outside of the 7 geographic locations.

The Moratoria Provider Services and Utilization Data Tool has interactive maps and data that shows provider and supplier services on a national, state, and country level. It also has utilization data that could be used to determine which areas might be considered for a moratorium for new provider and supplier enrollments.

The data gives the number of provider and supplier services and identifies moratoria regions. It also identifies the number of people with Medicare benefits that have a specific health service in that region.

This data can be used to show service levels that relate to the amount of providers and suppliers in a geographic region. This can be compared using interactive maps.

Public Provider data makes it easy for users to access and validate provider and supplier information against Medicare data. The Public Provider Enrollment file includes information on suppliers and providers nationwide who are approved to bill Medicare. Data is updated quarterly and comes from the Provider Enrollment, Chain and Ownership System (PECOS).

By using ground ambulance and home health agency paid claims data in the CMS systems for Medicare FFS beneficiaries, it created the Moratoria Provider Services and Utilization Data Tool. The data for this will continue to be updated quarterly.

Data released will cover the period from October 1, 2014 to September 30, 2015 and is available for all 50 states, including the District of Columbia.

“Use of these tools gives us evidence of the use, disproportion, and saturation of certain services within Medicare, Medicaid, and CHIP coverage and provides insight beneficial to reducing program threats, assisting law enforcement, and averting harm to patients and the public,” Agrawal said.