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Guide to Statistics and Methods
July 2018

Practical Guide to Surgical Data Sets: Medicare Claims Data

Author Affiliations
  • 1Department of Surgery, University of Michigan, Ann Arbor
  • 2Institute for Healthcare Policy and Innovation, Ann Arbor, Michigan
  • 3Surgical Innovation Editor, JAMA Surgery
JAMA Surg. 2018;153(7):677-678. doi:10.1001/jamasurg.2018.0489

The Centers for Medicare and Medicaid Services (CMS) administers Medicare, the primary US health insurance program for people aged 65 years and older and people who qualify for Social Security Administration disability benefits (Box). Medicare includes Part A, which is hospital insurance; Part B, medical insurance; Part C, Medicare Advantage (private health insurance approved by the CMS and paid on a per-capita basis); and Part D, prescription drug coverage. The CMS maintains and makes several data files available for purchase (https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/FilesForOrderGenInfo/index.html). Because the Medicare Advantage data are administered by private insurance, these claims are unavailable. However, national fee-for-service Medicare files are available and represent approximately 70% of beneficiaries.

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