OVERVIEW OF CMS(Previously HCFA)

The daily operation of the Medicare and Medicaid programs involves the processing, adjudication, and payment of individual claims for health care services. Disbursement of program funds is subject to numerous guidelines, schedules, and rules. As a result, extensive records are maintained on program participants, services, and payments. Administrative record-keeping requires the daily update of very large databases. While claims processing is distributed between many Medicare contractors and state Medicaid agencies, CMS maintains a central repository of administrative records for program oversight, research, and evaluation purposes. By linking, tabulating, sampling, and summarizing the records in the administrative databases, the Office of Information Services (OIS) creates analytic data files and program statistics required by various CMS organizations for program management and policy development. The level of detail provided by the administrative records enables the creation of data files that support many analyses including patterns of service utilization and associated costs, and their variations across geographic areas, demographic groups, and diagnoses. The availability of person- and procedure-specific data also makes these files useful for epidemiological research applications. The following text describes how Medicare and Medicaid data are organized and presented in the Data section of the guide. Included are descriptions of the categories used to group and describe the data and a table that provides an overview of files discussed in the guide.

Overview of CMS Data | Data Organization | File Discussion | Overview of Data | OIS