Physician Performance Module (PPM)
U.S. Clinicians' Procedures & durable medical equipment (DME) & Prosthetics, Orthotics, and Supplies (POS) Orders.
The Physician Performance Module (PPM) is a subset of the Authoritative Physician Database, containing the coded procedures and office visits performed by physicians and other clinicians for their Medicare patients, as well as their DME and POS (prosthetics, orthotics, and supply) orders. Physician names and addresses are not included; to link the PPM data to practice and physician contact data, license information, and more, the PPM integrates with the CarePrecise Master Bundle using the NPI number as the relational key. Payment totals, as found in the APD, are not included, but payment data for individual physician procedures are present.
Because the source data for the PPM is collected, processed and released once per year by the Centers for Medicare and Medicaid Services, it is offered as a single purchase only, with the exception of redistribution licensees, who will receive it upon each update through the term of the license.
Used in conjunction with the Master Bundle, the PPM offers insight into physicians' medical procedure volumes and charges, and can be used to roll up medical procedure volumes per practice location. Adding the Authoritative Hospital Database, it becomes possible to view medical services volumes within a health system/hospital macrocosm.
Product Details
CarePrecise data sets connect together to form a unified provider database. Add the Master Bundle data set to the Physician Performance Module, it is possible to see all of the providers who practice together, including physicians, nutritionists, RNs, and all other taxonomies of healthcare providers, as well as their organizations and employers, using CarePrecise's exclusive CoLoCode co-located provider identifier. Medical procedures and orders and charges by individual physicians can this be rolled up to particular practice locations.
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| Data Table/File Name | Field Name | Description | Data Type | Size | |||||||
DB FILE: Procedures.mdb |
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APD_PhysicianProcedure Physician procedure volumes and counts of services and patients served, from CMS-collected reporting, according to Medicare Clinician Utilization data. Effective 7/22/2022, Procedures will include the CMS Clinician Utilization data release, in compliance with copyright, and the procedure code field name will be changed to Proc_Code. For the complete procedure report, user may review and download at this link. Also included is a CSV version of this table. |
NPI | National Provider Identifier of clinician | Text | 10 | |||||||
| Proc_Code | Procedural code billed by the clinician. | Text | 24 | ||||||||
| ServiceCount | Frequency of individual clinician's performance of the associated code within the calendar year. | Text | 10 | ||||||||
| BeneficiaryCount | The number of beneficiaries that received the service or procedure identified by the code. | Text | 10 | ||||||||
| MeasureYear | The most recent year of procedure data reported by CMS. | Text | 4 | ||||||||
APD_ProcedureDescriptions Physician procedure volumes according to Medicare Clinician Utilization data. Ongoing extraction from CMS-collected reporting. Abbreviated descriptions. Effective 7/22/2022, Procedures will include the CMS Clinician Utilization data release, in compliance with copyright, and the procedure code field name will be changed to Proc_Code. Also included is a CSV version of this table.
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Proc_Code | Procedural code billed by the clinician | Text | 24 | |||||||
| ProcedureDescription | Lay-friendly description of procedure associated with the procedure code | Long Text | Long Text | ||||||||
DB FILE: DMEPOS.mdb |
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APD_PhysicianDMEPOS Physician Durable Medical Equipment (DME) orders, listing DME ordered by physician, and counts of services, claims, suppliers and patients served, from CMS-collected reporting. Effective 7/22/2022, the code field name will be changed to DME_Code. Additional changes will be coming in the Fall of 2022 or early 2023. Also included is a CSV version of this table. |
NPI | National Provider Identifier of clinician | Text | 10 | |||||||
| DME_Code | Code for the specific product or service furnished by the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier. Level II codes. | Text | 24 | ||||||||
| Rental | Identifies whether the DMEPOS product/service submitted on the supplier's claim is rental or non-rental - Y = rental, N = non-rental | Text | 1 | ||||||||
| Suppliers | Number of suppliers rendering DMEPOS products/services ordered by the referring provider | Text | 12 | ||||||||
| Beneficiaries | Number of beneficiaries associated with the supplier DMEPOS products/services ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. | Text | 12 | ||||||||
| Claims | Number of DMEPOS claims submitted by the supplier, reflecting products/services ordered by the referring provider. Aggregated records based on claims fewer than 11 are not included. | Text | 12 | ||||||||
| Services | Number of DMEPOS products/services rendered by the supplier | Text | 12 | ||||||||
| AvgSubmittedCharge | Average of the charges that suppliers submit for DMEPOS products/services. Total submitted charges can be calculated by multiplying the AvgSubmittedCharge by the Services. | Double | |||||||||
| AvgMedicareAllowAmount | Average Medicare allowed amounts for the DMEPOS product/service rendered by suppliers. Allowed: amount Medicare pays, deductible and coinsurance the beneficiary pays, amounts that a third party pays. Total Medicare allowed amounts can be calculated by multiplying the AvgMedicareAllowAmount by the Services. | Double | |||||||||
| AvgMedicarePaymentAmount | Average amount Medicare paid suppliers after deductible and coinsurance amounts have been deducted for the line item DMEPOS product/service. Total Medicare payment amounts can be calculated by multiplying the AvgMedicarePaymentAmount by the Services. | Double | |||||||||
| AvgMedicareStandardAmount | Average amount Medicare paid suppliers after deductible and coinsurance amounts have been deducted for the line item DMEPOS product/service. Total Medicare payment amounts can be calculated by multiplying the AvgMedicarePaymentAmount by the Services. | Double | |||||||||
| MeasureYear | Year of care the data reflects (most recent CMS data release on this physician) | Text | 4 | ||||||||
| Classification | BETOS Classification Group. High level grouping of the BETOS Classifications into three groups including Durable Medical Equipment, Prosthetic and Orthotic Devices, and Drugs and Nutritional Products. | Text | 255 | ||||||||
| RUCA | The rural-urban commuting area (RUCA) codes classify U.S. census tracts using measures of population density, urbanization, and daily commuting | Text | |||||||||
| EntityType | NPI Record Type 1=individual, 2=organization | Text | |||||||||
tAPD_DMEPOSDescriptions Physician DME order volumes. Ongoing extraction from CMS-collected reporting. Abbreviated descriptions.Also included is a CSV version of this table. |
DME_Code | Code for the specific product or service furnished by the Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supplier | Text | 24 | |||||||
| DME_Description | Lay-friendly description of procedure associated with the DMEPOS code | Long Text | 255 | ||||||||
Touch here for a mobile-friendly PDF version of the full listing of the data fields in the PPM...
DELIVERY
Immediate download from our online store. Optional shipping via mail on a DVD disk or thumb drive is also available. Optional secure, automation-friendly FTP push delivery is available for subscribers.
FILE FORMATS
The downloaded zip file contains the PPM in two file formats, each containing identical data:
- Comma Separated Values (.csv); normalized relational tables; may be used in Excel or imported into any spreadsheet or database software on Windows, Mac or Linux system.
- Microsoft Access 2003/2007/2010/2013 (.mdb); normalized relational tables, with example queries.
SUPPORT
The Single Download option includes 30 days of free Telephone Technical Support. Subscription options come with 90 days of free Telephone Technical Support. Ongoing technical support via email. See support details.
LICENSING
CarePrecise data is licensed for use by the purchaser and may not be redistributed, placed in a data lake, or used to produce a commercial derivative product without an additional license agreement. Special licensing is available. Unless a redistribution or multi-user license is obtained separately, the standard End User License Agreement permits the licensee to use the data in any way desired as long as it is within and for the buyer's own organization and is used by only one user at a time (may not be installed on multiple computers for use by multiple simultaneous users). Alternative licensing options are available for uses that involve distribution of the data or use of the data by more than one user and/or for public viewing, and are purchased separately. For information on licensing CarePrecise data for use in your web applications, products or services, phone 1 (877) 782-2294 extension 9.
MORE INFORMATION
Contact CarePrecise Sales at (877) 782-2294, sales@careprecise.com