OTHER UTILIZATION FILES

The Other Utilization Files group contains two databases or files:

• Provider Summary File
• Physician Summary File

The Other Utilization Files pre-date the advent of the CWF (as do the MEDPAR File and BMAD files).

Provider Summary File

The Provider Summary File contains summarized utilization information for Medicare-certified hospitals. The file includes information such as number of claims, days of care, charges, and payment amounts.

File Creation

The Provider Summary File is created from CWF institutional claims records. The claims records received by CMS (previously HCFA) are assembled into files each week. Each month, four or five weekly files are merged into a monthly claims file. At the end of each month, the files are summarized by provider. Monthly files are available from 1987 onward.

File Maintenance

Monthly files containing summary data for each provider are processed as described in File Creation.

File Structure and Usage

The Provider Summary File contains utilization information summarized by Medicare-certified hospitals, including number of claims, days of care, charges, and payment amounts. The unit of analysis is the provider. CMS uses this file primarily for monitoring and projecting patterns of hospital admission and length of stay.

Data Structure and Usage

The Provider Summary File is a sequential flat file containing fixed length records sorted by provider number. Each record consists of approximately 40 data elements including the number of discharges and days of care for beneficiaries who are aged and beneficiaries with disabilities, and payment and charge information for each claim type. Monthly files are available beginning in 1987. The July 1995 file contains approximately 309,000 records.

Methods of Access

The Provider Summary File is stored on tape at the HDC.

Migration of Data

The Provider Summary File has not changed significantly with the advent of the current CMS claims processing environment.

List of Data Elements

A list of the data elements contained in the Provider Summary File, along with brief definitions and coding schemes, will be included in the future on the CMS web site at www.cms.hhs.gov.

Physician Summary File

The Physician Summary File contains summary information on the total annual Medicare charges, payments, and services (denied/allowed) for participating providers, non-participating providers who accept assignment, and non-participating providers who do not accept assignment. The summaries are based on Specialty Code, UPIN, Carrier Identification Number, and Locality Code.

File Creation

The Physician Summary File is created using all physician line items received for services performed in a given year. CMS (previously HCFA) creates this file by extracting information weekly from the Common Working File (CWF) claim records. Weekly extractions are summarized into quarterly final action files based on the last date of service. The annual file is constructed by merging the quarterly files. Because the data for this file comes from the CWF, CMS subjects the data to the National Claims History Quality Assurance System (NCHQAS).

File Maintenance

The Physician Summary File is created on an annual basis.

File Structure and Usage

The Physician Summary File summarizes Medicare charges, payments, and services (allowed and denied) for a given service year. The summary keys are Specialty Code, UPIN, Carrier Identification Number, and Locality Code. The Provider categories are totaled based on participating providers, non-participating providers who accept assignment, and non-participating providers who do not accept assignment. The file is used for research purposes.

Data Structure and Usage

The Physician Summary File is a sequential flat file that contains fixed-length records sorted by Specialty Code, UPIN, Carrier Identification Number, and Locality Code. The file contains approximately 800,000 records per year; the data are derived from all physician line items.

Methods of Access

The Physician Summary File is available for research and other approved program purposes. The file is stored on robotic cartridges at the HCFA Data Center.

Migration of Data

The Physician Summary File is available from 1991 to the present.

List of Data Elements

A list of the data elements contained in the Physician Summary File, along with brief definitions and coding schemes, will be provided in the future on the CMS web site at www.cms.hhs.gov.