CMS Data on Medicare Providers Released and Explained

On April 9, 2014, CMS publicly released data regarding utilization and payments to physicians and other suppliers from 2012. The data set, the Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File (PUF), contains this information organized by National Provider Identification (NPI) number, Healthcare Common Procedure Coding System (HCPCS), and place of service. Along with the data release, CMS provided answers to frequently asked questions (FAQs) as well as comments in a press conference call regarding the reasons behind the release. Further, the New York Times has released a search tool for the data, which covers information for over 800,000 providers.

Data Released

Specifically, according to CMS, the PUF contains “100 [percent] final-action physician/supplier Part B non-institutional line items for the Medicare fee-for-service population,” for calendar year 2012. A previous report covered the CMS announcement of this release and stated that the data to be made public contained information from approximately 880,000 providers covering 6,000 types of services and representing $77 billion in payments. That report also noted that CMS made the determination to release this information after balancing patient privacy rights and the public interest in releasing the information and noted that certain information regarding services that were provided to less than 11 total beneficiaries were redacted.

CMS Comments

In the press conference call, CMS representatives Jonathan Blum, CMS principal deputy administrator, and Niall Brennan, acting director of the CMS Offices of Enterprise Management, confirmed the previously reported findings on the release of the information. Moreover, Blum stated in his opening comments that “for far too long this information was not made public,” and claimed that the decision to finally release the information was a function of the following considerations: (1) that the public has a fundamental right of access to this data because Medicare is funded with taxpayers dollars; (2) that Medicare spending varies throughout the country and the release of this information may help to identify and understand this variation more; and (3) that the release will similarly help to identify and investigate fraud and waste within the Medicare system. In a follow-up to the issue of fraud, Brennan admitted that some of the data may represent the inappropriate practice of more than one provider submitting claims through a single provider’s NPI number, which is not always an approved practice by CMS and is another reason to broadcast this data.

FAQs and Other Resources

The FAQs webpage related to the PUF release covers an array of topics and allows users to submit questions online regarding the release. The general PUF release page also contains the data in two different formats: in a tab delimited file format and in a series of Microsoft Excel files organized by the provider’s last name. CMS also included summary tables and information on data methodology for the PUF on its website. The New York Times search function allows a user to search for 2012 Medicare Part B information that is part of this release by provider name, specialty, city, or zip code.