Linking Medicare, Medicare and Assessment data for Medicare Enrollees Frank Eppig – Some obstacles to linkage Dan Gilden – Validation of linkage algorithms Brian ODonnell – Linkage in the CCW Jerry Riley – Linkage to external data Obstacles to Linking Medicare, Medicare and Assessment data for Medicare Enrollees CMS does not control the assignment of personal identifiers used in the Medicare program, the Medicaid program, or MDS, OASIS, and IRF assessments Both Medicaid and Assessment data include individuals who are not covered by Medicare Assignment of Medicare Health Insurance Claim Numbers, HICN CMS doesn’t assign HICs to Medicare enrollees The Railroad Retirement Board (RRB) assigns HICs to those receiving RRB benefits The Social Security Administration assigns HICs to all others eligible for Medicare benefits including those who are not eligible for SSA benefits., such as federal employees The Medicare Health Insurance Claim Number (HICN) Comprised of two parts: 1) Claim Account Number (CAN) – is the policy number of the wage earner who earned Medicare benefits 2) Beneficiary identification Code (BIC) – identifier the current relationship between the beneficiary and the wage earner. When the beneficiary is not the wage earner the HIC is an indirect form of identification. The Medicare Health Insurance Claim Number (HICN) For non-RRB individuals the HICN is comprised of the 9 digit SSN of the primary account holder and a 2 position BIC that shows the relationship of the enrollee For RRB individuals the CSAN may be six or nine digits and is preceded by a 1, 2 or 3 character BIC. The RRB uses fewer BICs than SSA and their BICs fail to distinguish between multiple claimants with the same relationship to the wage earner. The Medicare Health Insurance Claim Number (HICN) All HICNs have the same internal CMS format structure regardless of whether issued by SSA or the RRB Within CMS IT systems, the HICN is captured as and 11 position field with a 9 position CAN and 2 position BIC. An enrollee’s HICN can change BIC change: When an enrollee’s relationship to the primary account holder changes their BIC changes, e.g. the shift from spouse to widow. CAN change: A Medicare enrollee may shift the account through which they receive Medicare benefits, e.g. a shift from receiving benefits under their own account to receiving benefits through a spouses' account. Linkage Based Upon HICS For CAN changes CMS maintains cross- reference records which map earlier HICS to later HICS For BIC changes, CMS forms groups of BICs. BICs within the same group are treated as equivalent for matching purposes. Medicaid Identifiers There are 53 Medicaid programs, each has their own system to enumerate Medicaid recipients Individuals who have qualified for Medicaid benefits in multiple jurisdictions usually have multiple Medicaid identifiers. In some cases individuals who move on and off Medicaid rolls within the same state will have multiple Medicaid identifiers. Medicaid Identifiers 22.6% of those in 2007 denominator file have a Medicaid link key. This overstates 2007 Medicaid / Medicare dual eligibles as it includes all those that had Medicaid coverage at some time in their Medicare career. 17.5% of those in 2007 denominator file have a buy-in indicator for 2007. 11.5% of the 2007 Medicare population who have a Medicaid link key have more than one MSIS ID. Assessment Identifiers Each state has their own system to enumerate identifies for the Assessments (Resident ID) Individuals who receive assessment in multiple jurisdictions usually will have multiple Resident IDs. In some cases individuals who move on and off the home health or nursing home roles will have multiple Resident IDs. Assessment Identifiers 31.4% of the 2007 denominator population have an assessment link key. This number is cumulative meaning that they had an assessment at some time in their Medicare career Roughly 7% of the 2007 Medicare population who have an Assessment link key have more than one Resident ID. Linkage logic For each of the three data systems (Medicare, Medicaid and assessments) develop an unduplicated person based identifier. – MSIS IDs to a person based Medicaid Link Key; – HICNs to a person based Medicare Link Key and – resident IDs to a person based Assessment link key Link these unduplicated identifiers across the three data systems.
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