On October 1, 2015, CMS converted from the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) to the 10th Revision, Clinical Modification (ICD-10-CM) and Procedure Coding System (ICD-10-PCS).

The objectives of this document are to: 1) verify that the CCW received Medicare claims after the ICD-10 conversion without disruption and demonstrate the impact on claims volume in the initial months of the conversion and 2) evaluate the impact of the conversion from ICD-9 to ICD-10 codes on prevalence estimates for the CCW condition algorithms.

 

As of May 2017, the Master Beneficiary Summary File (MBSF) includes Medicare enrollment information from the CMS Common Medicare Environment (CME) rather than the CMS Enrollment Database (EDB). The CME improves the identification of Medicare Part B enrollment and also allows for more timely release of the MBSF.

While investigating the accuracy of the MBSF, CMS discovered that under rare sets of circumstances, there were changes to a beneficiary's enrollment record that were not reflected in the monthly EDB loads to the CCW. There were times when an enrollment record in the CCW EDB should have been marked as no longer current, but was mistakenly retained as a current record (i.e., enrollment record should have been marked as no longer active for certain months - and this did not occur).

 

Medicare administrative claims data are useful for monitoring service utilization – including hospitalizations, home health and physician office visits. Claims generally take many months to be considered ‘final' – and be mature enough that the data produce stable estimates of service use, reasons for service, and payments. However, timely information allows investigators to monitor the progress of programs and interventions, enabling mid-course adjustments to improve results.

The objective of this document is to describe the completeness of Medicare Institutional fee-for-service (FFS) claims, Medicare Non-Institutional FFS claims, and Part D Events (PDEs) at different levels of claims maturity (i.e., after different amounts of time have elapsed from the service date to the claim processing date).