Скачать презентацию Outlines Medicare Program Medicare Coverage Entitlement Скачать презентацию Outlines Medicare Program Medicare Coverage Entitlement

ad5e599df49658ee492b7acfa2023aee.ppt

  • Количество слайдов: 128

Outlines Outlines

Medicare Program Medicare Program

Medicare Coverage (Entitlement) Medicare Coverage (Entitlement)

Medicare Part A Benefits Medicare Part A Benefits

Part A Eligibility Part A Eligibility

Part B Benefits Part B Benefits

Medicare Funding and Payment Medicare Funding and Payment

Types of Medicare Program Types of Medicare Program

Bill and Claims Bill and Claims

Type of Services Type of Services

Claim Forms Claim Forms

Research Claim Files Research Claim Files

SAFs and Med. PAR SAFs and Med. PAR

Example: Emergency Room Visit Example: Emergency Room Visit

Demographic Variables Demographic Variables

Age Age

Race/ethnicity Race/ethnicity

Sex Sex

Mortality Mortality

Medicare Enrollment Status Medicare Enrollment Status

State Buy-in State Buy-in

HMO indicator HMO indicator

Dual Eligible Status Dual Eligible Status

Beneficiary Residency Beneficiary Residency

Type of Claims Type of Claims

UB 92 /UB-04 Form UB 92 /UB-04 Form

Hospitalization/Med. PAR Hospitalization/Med. PAR

Finding Provider (Hospitals) Finding Provider (Hospitals)

Diagnosis, Procedures and DRGs Diagnosis, Procedures and DRGs

Example: AMI Example: AMI

ICD-9 V codes ICD-9 V codes

Hospital Charges& Payments Hospital Charges& Payments

Estimating Payments from Med. PAR Estimating Payments from Med. PAR

Charge/Reimbursement Ratio Charge/Reimbursement Ratio

Discharge Destination Discharge Destination

Additional Comments on Med. PAR Additional Comments on Med. PAR

Outpatient Claim File Outpatient Claim File

Basic Claim File Basic Claim File

Physician NPI Physician NPI

Revenue Center files Revenue Center files

Revenue Centers Revenue Centers

HCPCS examples HCPCS examples

HCPCS Modifiers HCPCS Modifiers

Services Unit and Payment Services Unit and Payment

Carrier Files Carrier Files

Carrier Basic Claim File Carrier Basic Claim File

Carrier Line Item File Carrier Line Item File

Line Diagnosis and Procedure Line Diagnosis and Procedure

BETOS codes BETOS codes

Physician Information Physician Information

Example: Line Physician Specialty Example: Line Physician Specialty

Example: Line Place of Service Example: Line Place of Service

Line Type of Services Line Type of Services

Line Charge and Payment Line Charge and Payment

Line Service Units Line Service Units

Medicare Part D data Medicare Part D data

Part D Enrollment Part D Enrollment

Monthly Drug Plan Contract ID Monthly Drug Plan Contract ID

Cost Share Group Cost Share Group

Part D Event Data Part D Event Data

Other Drug Information Other Drug Information

Medication Days and Supply Medication Days and Supply

Medication Adherence Medication Adherence

Payment and Coverage Payment and Coverage

Characteristics Data Characteristics Data

Note on Requesting Drug Data Note on Requesting Drug Data

Other Claim Data Other Claim Data

Limitations of Medicare Limitations of Medicare

Limitations (cont. ) Limitations (cont. )

Before You Request… Before You Request…

Researcher’s Tasks Researcher’s Tasks

Role of Res. DAC Role of Res. DAC

Requesting Package Requesting Package

Data Use Agreement (DUA) Data Use Agreement (DUA)

CMS Review Criteria CMS Review Criteria

Other Res. DAC Services Other Res. DAC Services

CCW data CCW data

Chronic Conditions Chronic Conditions

Chronic Conditions Chronic Conditions

Create Study Cohort Create Study Cohort

Example: West TN Beneficiaries Example: West TN Beneficiaries

Example: BPH Cohort Example: BPH Cohort

Research Finder File Research Finder File

Linking with Different Files Linking with Different Files

Matching Between Different Claims Matching Between Different Claims

Linking with Other Files Linking with Other Files

Defining Outcomes Defining Outcomes

Time to Event Outcome Time to Event Outcome

Identifying Comorbidities Identifying Comorbidities

Charlson Score Distribution Charlson Score Distribution

Forming Analytic Files Forming Analytic Files

Comparative Effectiveness Analysis Comparative Effectiveness Analysis

BPH Cohort BPH Cohort

Defining First BPH Surgery Defining First BPH Surgery

Defining Outcomes Defining Outcomes

Comorbidities Comorbidities

Socio-economic data Socio-economic data