Frequently Asked Questions

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FAQ

By Topic: Medicare Provider Utilization and Payment Data Subtopic: Referring Provider DMEPOS


Who pays the difference between what the provider charges and Medicare pays?
The provider has an ... (more)

What is the source for the Referring Provider DMEPOS PUF?
The primary data sou... (more)

Why does the average Medicare payment amount differ across referring NPIs for the same HCPCS code in the Re...
The data in the Refe... (more)

How did CMS calculate the values in the Referring Provider DMEPOS PUF?
The spending and utilization data in ... (more)

My physician has two practice locations. Can I use the Referring Provider DMEPOS PUF to figure out the tota...
No, the Referring Provider DMEPOS PUF do... (more)

Don’t physicians and other healthcare professionals have a privacy interest in the data in the Referring ...
Prior to deciding to release physician a... (more)

Where can I find the standard payment by HCPCS code to compare to the data in the Referring Provider DMEPOS...
For standard payment and allowed amount ... (more)

Does the Referring Provider DMEPOS PUF include non-physician practitioners, such as nurse practitioners?
Yes, you can filter on the referring_pro... (more)

Is the allowed amount in the Referring Provider DMEPOS PUF the amount that a Medicare beneficiary actually ...
No. This figure includes the amount Medi... (more)

What do I do if I think I’ve identified fraud in the Referring Provider DMEPOS PUF?
CMS is committed to the prevention and d... (more)

What is the population included in the Referring Provider DMEPOS PUF?
... (more)

Can I use the data in the Referring Provider DMEPOS PUF to create graphics, applications, or tools?
Yes, this data is public information.... (more)

Can I link the Referring Provider DMEPOS PUF to other data CMS releases or other public data?
When linking data from this file to othe... (more)

When I open the Referring Provider DMEPOS PUF in Excel, I get an error, why?
The Referring Provider DMEPOS PUF contai... (more)

In the Referring Provider DMEPOS PUF how are averages calculated for the avg_supplier_Medicare_allow_amt, a...
The average payment and charge variables... (more)

The documentation for the Referring Provider DMEPOS PUF indicates that for the line_srvc_cnt the metrics us...
Service counts may be calculated in diff... (more)

In the Referring Provider DMEPOS PUF what is the definition for the line_srvc_cnt variable?
The line_srvc_cnt reflects the number of... (more)

Does anyone actually pay the submitted charges in the Referring Provider DMEPOS PUF?
In the private market, patients with comprehensive coverage ... (more)

Why hasn’t CMS included information on quality in the Referring Provider DMEPOS PUF?
CMS has started publishing quality-of-ca... (more)

Does the average Medicare payment amount field in the Referring Provider DMEPOS PUF need to be adjusted?
No, the avg_supplier_Medicare_pmt_amt re... (more)

Does the Referring Provider DMEPOS PUF contain information for beneficiaries in Medicare Advantage? What ab...
No, the Referring Provider DMEPOS PUF on... (more)

How are you protecting beneficiary privacy in the Referring Provider DMEPOS PUF?
CMS takes beneficiary privacy very serio... (more)