Claims-Based Measures

The Centers for Medicare & Medicaid Services (CMS) uses a variety of data sources to determine the quality of care that Medicare beneficiaries receive.

For the quality of care measure sets listed below, CMS uses Medicare enrollment data and Part A and Part B claims data submitted by hospitals for Medicare fee-for-service patients. (Hospitals are not required to submit additional data for the claims-based measures.)

Each measure set is calculated using a separate, distinct methodology and, in some cases, separate discharge periods. (For the AMI, HF, PN Mortality and Readmission measures, administrative data from Veterans Administration (VA) medical centers are also used.)

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