Medicare Part A vs Part B
Medicare Part A covers hospital services (inpatient and outpatient) while Medicare Part B covers outpatient services outside of a hospital setting. In other words, Part B covers standard office visits, such as a visit to a Primary Care Physician.
The greatest impact of Medicare A and B is two-fold: frequency of release and granularity of data.
Part A is on a six month lag and is released on a quarterly basis, so we receive hospital claims from Q1 of a given year in Q4. In this data, we can see all important information about an encounter, such as physicians (even though it's a hospital claim), facility, medical codes, anonymous patient ID, etc.
Part B is on an 18 month lag and is released annually; this means that there is an 18 month wait to receive data after a calendar year closes. This data is reported in aggregate, so it does not include not claims-level information and cannot be tied to a specific patient.
Some impacts of reliance on Part B are:
- Age of data
- Care clusters with certain conditions do not work with Part B (e.g. AND, AND NOT, or time-based)
- Case Loss does not work with Part B
- Procedure referrals does not work with Part B
- We cannot tie volumes to a facility from Part B
- We cannot determine affiliations from Part B
Medicare Part C
Part C is Medicare Advantage (MA) which are private health plans contracted with the government.
Medicare Part D
This includes Medicare drug data and is similar to Part B with regard to the leg time and limitations.