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SAS Programming with Medicare Administrative Data, 2nd Edition

Name: SAS Programming with Medicare Administrative Data, 2nd Edition
Author: Matthew Gillingham
ISBN: 9781629591537

by Matthew Gillingham

May 2014

Beginner to intermediate

168 pages

4h 54m

English

SAS Institute

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About This Book
About The Author
Acknowledgments
Chapter 1: Introduction
Introduction and Purpose of This BookFramework of This BookOur Programming ProjectChapter OutlineHow to Use This BookDisclaimerChapter Summary
Chapter 2: An Introduction to the Medicare Program
Introduction and Goals of the ChapterAn Introduction to the Medicare ProgramWhat is Medicare?Medicare Enrollment and EligibilityWhat Is Covered by Medicare?What Is Not Covered by Medicare?The Mechanics of MedicareChapter Summary
Chapter 3: An Introduction to Medicare Data
Introduction and Goals of This ChapterA Note on the Source and Structure of Our Claims DataPart B Carrier Claims DataDurable Medical Equipment (DME) DataOutpatient Claims DataInpatient Claims DataSkilled Nursing Facility (SNF) Claims DataHome Health Claims DataHospice Claims DataCommonly Retained Elements in Administrative Claims DataMaster Beneficiary Summary FileProvider DataExample: Identification of Emergency Department (ED) UtilizationExample: Identification of Surgical ServicesChapter Summary
Chapter 4: Planning the Research Programming Project
Introduction and Goals of This ChapterOur Project’s Plan: The SDLCOur Project’s High-Level RequirementsOur Project’s Quality Assurance PlanOur Project’s FlowchartOur Project’s Data Storage and LIBNAMESOur Research Programming Technical SpecificationsChapter Summary
Chapter 5: Request, Receive, Load, and Transform Data
IntroductionRequesting Medicare Administrative Claims and Enrollment DataSources of Medicare Claims and Enrollment DataData Available from CMSOur Project’s Data Requirements and Request SpecificationsContacting ResDAC and Completing PaperworkReceiving, Decrypting, and Loading Medicare Administrative Claims and Enrollment DataReceiving Our Medicare Administrative DataDecrypting Our Medicare Administrative DataLoading Our Medicare Administrative Data into SAS Data SetsAlgorithms: Transforming Base Claim and Line Level Data Sets into Single Claim-Level FilesTransforming Base Claim and Line-Level Carrier Data into a Claim-Level FileChapter Summary
Chapter 6: Working with Enrollment Data
Introduction and GoalsReview and ApproachBasics of Medicare Enrollment DataOur Programming PlanAlgorithms: Identifying Continuously Enrolled FFS BeneficiariesWhy Define Continuously Enrolled FFS Beneficiaries?How to Specify the Programming for Continuous Enrollment in Medicare FFSMedicare Part A and Part B Enrollment VariablesHMO Coverage VariableDate of Death VariableHow to Program in SAS to Define Continuous Enrollment in Medicare FFSAlgorithms: Create or Retain Data Elements for Displaying Results by Certain CharacteristicsCoverage Characteristics, Month of Death, Sex, and RaceAge GroupsGeographic CharacteristicsAlgorithms: Create Final Enrollment Data for Remainder of ProgrammingChapter SummaryExercises
Chapter 7: Measuring Utilization of Services
Introduction and GoalsReview and ApproachReview: Basics of Medicare Claims DataOur Programming PlanAlgorithms: Delimit Claims by Continuously Enrolled Beneficiary PopulationAlgorithms: Measuring Evaluation and Management (E&M) UtilizationAlgorithms: Measuring Inpatient Hospital UtilizationAlgorithms: Measuring Emergency Department UtilizationAlgorithms: Measuring Utilization of Ambulance ServicesAlgorithms: Measuring Outpatient Visit InformationAlgorithms: Measuring Utilization of SNF, Home Health Agency, and Hospice CareChapter SummaryExercises

Chapter 8: Measuring Costs to Medicare
Introduction and GoalsReview and ApproachReview: Basics of Medicare CostOur Programming PlanA Note on Payment Standardization and Risk AdjustmentAlgorithms: Measuring Evaluation and Management PaymentsAlgorithms: Measuring Inpatient Hospital PaymentsAlgorithms: Measuring Total Part A PaymentsChapter SummaryExercises
Chapter 9: Programming to Identify Chronic Conditions
Introduction and GoalsReview and ApproachReview: Peculiarities of Medicare DataOur Programming PlanA Note on the Chronic Conditions Data Warehouse (CCW)Algorithms: Identifying Beneficiaries with Diabetes or COPDAlgorithms: Evaluation and Management Visits for Beneficiaries with Diabetes or COPDAlgorithms: Diabetic Eye Exams for Beneficiaries with DiabetesAlgorithms: Hospital Readmissions for Beneficiaries with COPDChapter SummaryExercises
Chapter 10: Presenting Output and Project Disposition
IntroductionSynthesis – Review and ApproachReview: Our AccomplishmentsOur Programming PlanAlgorithms: Presenting Selected Measurements of Utilization, Cost to Medicare, and Quality OutcomesPresenting Ambulance UtilizationPresenting Medicare Payments for Evaluation and Management Services by ProviderPresenting Rates of Diabetes and COPDAlgorithms: Presenting Inpatient Length of Stay Information by StateAlgorithms: Presenting Mean Medicare Part A Payments per Beneficiary by State and CountyAlgorithms: Presenting Rates of Diabetic Eye ExamsProduction Execution in BatchProject DispositionArchiving Materials for Future UseData DestructionChapter SummaryExercises
Index

Content preview from SAS Programming with Medicare Administrative Data, 2nd Edition

Chapter 8: Measuring Costs to Medicare

Introduction and Goals

Review and Approach

Review: Basics of Medicare Cost

Our Programming Plan

A Note on Payment Standardization and Risk Adjustment

Algorithms: Measuring Evaluation and Management Payments

Algorithms: Measuring Inpatient Hospital Payments

Algorithms: Measuring Total Part A Payments

Chapter Summary

Exercises

Introduction and Goals

Measuring cost is important because it gets to the heart of the sustainability of any insurance program, and Medicare is certainly no exception. It is no understatement to say that the measurement of cost in the Medicare program is a hot topic. Open any newspaper or magazine or turn on the evening news and you will see that reducing cost without negatively ...

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SAS Programming with Medicare Administrative Data, 2nd Edition

by Matthew Gillingham

Become an O’Reilly member and get unlimited access to this title plus top books and audiobooks from O’Reilly and nearly 200 top publishers, thousands of courses curated by job role, 150+ live events each month,
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