Medicare Payment System Data Files

Get the facility/locality-specific rate data you need to project financial outcomes and conduct strategic planning for your business lines 

Healthcare organizations, providers, consultants, life science companies, payers and software vendors struggle to understand and keep up-to-date with complex Medicare expected payment information. Analyzing published CMS information, which can be confusing, incomplete and difficult to aggregate into consistent format, is a major burden that eats through staff time. And, once they have the data in hand, they still have to calculate provider-specific or location-specific rates.

Our solution ensures you can:

  • Predict the financial outcome of a service, supply or device
  • Conduct strategic analyses of your business service line
  • Determine the financial viability of a potential new service or new device
  • Determine the financial viability of entering into a new or expanded market
  • Analyze your charge structure in comparison to Medicare payment rates

Medicare Payment System Data Files, powered by New Health Analytics, are accurate, consistent and versioned provider-specific data sets packaged “to go”—for reporting, analysis and to populate your software and IT systems with the essential data for projecting financial outcomes and strategic planning. 

Available Data Files:

  • Inpatient PPS: MS-DRG-based payment rate for every payable MS-DRG code calculated for each inpatient hospital.
  • Outpatient PPS: APC-based payment rate for every payable HCPCS/CPT code calculated for each outpatient hospital Ambulatory Surgical Center.
  • Fee Schedule: ASC fee schedule for every payable HCPCS/CPT code with wage index adjustment for each locality.
  • Physician Fee Schedule: RVU-based payment rate for every payable HCPCS/CPT code calculated for each carrier locality 
  • Clinical Laboratory Diagnostic Fee Schedule: Lab fee schedule for every payable HCPCS/CPT code adjusted for each state.
  • Durable Medical Equipment Fee Schedule: DME fee schedule for every payable HCPCS/CPT code adjusted for each state.
  • Long Term Care Hospital PPS: MS-DRG-based payment rate for every payable MS-DRG code calculated for each LTCH facility.

Key Features for Each Data File:

  • Content that is automatically updated at least quarterly
  • 5 years of archived data for each data file
  • Each version contains:
    • Zipped excel files
    • National unadjusted payment rates
    • State, geographic or provider-specific payment rates
    • All supporting variable definitions and explanation of the payment logic used 

All healthcare entities can benefit from using the Medicare Payment System Data Files:

  • Hospitals & Institutions: Benchmark and understand payment trends, create pricing based on Medicare expected payment, understand your own payment logic and compare to similar institutions.
  • Consultants: Assist customers with strategic planning, contract pricing, facilities comparison, and much more. Keep your propriety systems and tools up-to-date.
  • Healthcare Vendors: Keep information for clients up-to-date without having to do complex payment calculation within your own applications.
  • Medical Device Companies / Life Sciences: Get a clear understanding of geographic payment variables to support product pricing and market sizing.
  • Durable Medical Equipment / Clinical Lab: Use payment data files to understand revenue opportunities specific to each state.
  • Payers: Check and update payment logic to better understand Medicare expected payment.
  • Accountable Care Organizations: Support strategic planning and understand Medicare expected payment.

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