Provider of Services (POS) File

Institutional providers of service participate in the Medicare and Medicaid programs through a formal certification procedure which examines the institution's qualifications for furnishing safe and effective care to beneficiaries. The certification procedure is conducted under Federal guidelines by State agencies. Final certification approval is obtained through CMS (previously HCFA). After initial certification, an institution's qualifications are reviewed periodically to support a decision by CMS to retain or terminate its participation in the Medicare and Medicaid programs. The POS File contains data regarding provider certification and status such as facility and service characteristics, provider type, and location. Data are collected through surveys and standard CMS forms.

File Creation

POS File data are collected using a forms package that contains the Survey Report Form (SRF); HCFA Form 1539, Medicare/Medicaid Certification and Transmittal; and Medicare/Medicaid applications for certification. The SRF contains criteria used to measure an institution's capacity to provide acceptable care and the decisions of a surveyor in applying the certification criteria to a particular institution. The HCFA Form 1539 and the application form document characteristics such as staffing, number of beds, and services provided. All Medicare and Medicaid providers, including hospitals, nursing homes, Intermediate Care Facilities for the Mentally Retarded (ICFs/MR), Home Health Agencies (HHAs), hospices, clinical laboratories, End Stage Renal Disease (ESRD) facilities, Rural Health Clinics (RHCs), Ambulatory Surgical Centers (ASCs), Community Mental Health Centers (CMHCs), Federally Qualified Health Centers (FQHCs), and some suppliers, are included in these data collections. These data are collected annually for nursing homes and less frequently (every few years) for other providers. In the past, the complete forms package was sent online to central office update systems from the CMS regional offices where the source document files were maintained. Each provider's data elements were sorted and assembled nightly into a transaction record. Error free transactions were updated to a master file. These transactions data resided at the CMS Data Center (HDC) and were available through the Medicare/Medicaid Automated Certification System (MMACS) and the Rapid Data Retrieval System (RADARS). Presently, State agencies survey facilities and key survey information into the Online Survey Certification and Reporting System (OSCAR) using modems from microcomputers located at State agency sites. POS data elements are edited online during data entry. These edits include consistency checks to identify inordinate increases or decreases in provider characteristics such as number of beds or staffing. Only error-free transactions are posted to OSCAR; those with errors are held in a pending transaction file awaiting resolution. The POS File is created by extracting data from OSCAR quarterly. The fourth quarter file of every year is referred to as the annual file. The POS File was first created from OSCAR in 1991.

File Maintenance

Edits to POS data are described under File Creation. POS files are not updated after they are created.

File Structure and Usage

The POS File contains a large volume of descriptive information about providers including staffing, number of beds, and types of services. The provider is the unit of analysis. Providers are grouped into 16 categories such as hospitals, Skilled Nursing Facilities (SNFs), HHAs, x-ray facilities, ambulatory surgical centers, and comprehensive outpatient rehabilitation facilities. The OSCAR data from which the POS File is extracted are used by CMS in its survey of Medicare and Medicaid providers to monitor State agency and provider performance. The POS File is used internally by CMS to verify names and addresses of providers with information contained in other files. In addition, the file is of interest to sources external to CMS for marketing purposes. Users should be aware of the following limitations of the POS File. Some survey information may be up to three years old at any given time because accredited hospitals and some other providers are not recertified annually. In addition, a gap in the available data exists between March 1990 when MMACS was discontinued and October 1991 when OSCAR came online.

Data Structure and Usage

The POS File contains descriptive data such as provider name, address, number of part time and full time employees by type of staff, and how services are provided (e.g., not provided, provided by staff, provided under arrangement) for most Medicare and Medicaid providers. As of July 31, 1999, the file contained approximately 228,000 fixed length records organized by provider type and provider number. POS File records contain 2,400 data elements. Approximately 230 data elements are common to all provider categories. Subsets of the other data elements apply to individual provider categories so the fields on a record containing data vary by provider category. The POS File is used primarily to provide descriptive information about providers such as hospitals, SNFs, and HHAs, and some suppliers.

Methods of Access

OSCAR is the replacement system for MMACS and RADARS. OSCAR serves as both the access system and the data repository for provider survey and certification information. OSCAR cannot be directly accessed by users outside of CMS, but these users may request OSCAR reports or extract files from CMS staff. Internal CMS users with access to OSCAR have an online option that enables them to create a file for a specific provider type at any time. OSCAR maintains program compliance records for the current survey and three preceding surveys only. Descriptive information on provider characteristics is maintained for the current survey only. Quarterly snapshots of the POS File have been archived at CMS to maintain a permanent record. The POS File is available to internal CMS users as a sequential flat file in SAS and COBOL formats. Two PUF versions of the POS File are available to external users. The POS PUF, which was extracted from MMACS, is available for 1987 through 1989. The POS Extract PUF, which is extracted from OSCAR, is available beginning in 1991. These PUFs are discussed in the Public Use Files Data chapter.

Migration of Data

A gap in the POS data available exists between March 1990 when MMACS was discontinued and October 1991 when OSCAR came online. In the last few years, the number of provider types contained in OSCAR has increased. The last three provider categories added to OSCAR are Community Mental Health Centers, Federally Qualified Health Centers, and CLIA 88 laboratories. Prior to 1991, the POS record contained approximately 660 data elements. The number of data elements was increased by approximately 2,400 when provider categories and data elements were added.

List of Data Elements

The list of data elements will be included in the future on the CMS web site at www.cms.hhs.gov.

POS Introduction | POS | Provider Specific | MPIER