The timeliness of Medicare Fee-for-Service data release is ... a bit complicated. The simple version is as follows: Medicare Part A, which includes Inpatient and Outpatient claims is released on a six-month lag each quarter. That means that we'll usually have new Q1 data for any given year around September of that year, Q2 data in December of that year, Q3 in March of the following, etc. Part B, on the other hand, which covers data done outside of the Inpatient and Outpatient setting, is released only annually and on a much longer lag (eighteen months). The complicated part comes in when viewing data in the app, and in terms of the timeliness, it really depends: on what part of the app you are viewing (search vs report); on what codes you're using; on whether you're using Omni or Territory Manager. Because stitching data together can get messy, we try to keep the intricacy out of sight as much as possible for the sake of simplicity, but just know that we always default to the latest complete year of data we have available. We also allow for searching on partial years of data (at the time of this writing, for example, we allow you to view Q1 to Q3 of 2020, and we are currently uploading Q4!).
The timeliness of commercial data will vary based on when you purchased it. Commercial claims are made available very quickly, meaning there may be as little as one month of lag on the data, however for the most very recent months a significant claims may not be captured as these take time to be adjudicated.
Note that the way we display data differs based on whether you're viewing Territory Manager or Omni. Omni tends to display full calendar year data, though there are exceptions (such as Case Loss) while Territory Managers tends to display data on a rolling period, using the most recent 12 month period we have.
The following table gives a more comprehensive breakdown of when you can expect different data to be released. Keep in mind that once data is released, we have to order it, upload it, and QA it before we make it available in our live app. For claims data in particular, this can take some time since these are shipped via flash drive to our actual address, after which they must be manually uploaded. Yes, it's 2021 alright 🙂
|Data||Source||Timeline Lag||Notes & Examples|
|Inpatient Claims||CMS (Medicare)||6 months||We would expect to have Q1 of 2020 available by September of that year, and all of 2020 by mid-summer 2021|
|Outpatient Claims||CMS (Medicare)||6 months||We would expect to have Q1 of 2020 available by September of that year, and all of 2020 by mid-summer 2021|
|Clinic (attached to hospital)||CMS (Medicare)||6 months||We would expect to have Q1 of 2020 available by September of that year, and all of 2020 by mid-summer 2021|
|Clinic (not attached to hospital)||CMS (Medicare)||18 months||CMS claims coming from 2020 from unattached clinics and offices would be available for full year only, and not until mid-year 2022.|
|Ambulatory Surgical Center||CMS (Medicare)||9 months||Note that these are not claims but rather aggregate counts. This may seem trivial on the surface as you can still see the total number of procedures for a certain code, however the analytics stop there. Without claims, we can't do more complex analytics nor even tie procedures done to individual physicians.|
|Sunshine Act||Open Payments||9 months||We typically receive this data in August or September of the following year.|
|3 months||We have an in-house algorithm for determining affiliations, but a very important element of this is where physicians are billing, and when. We update affiliations whenever we get new claims data, which is quarterly.|
|Physician Addresses||NPPES, MCH||Depends||The short of it is that we rely on the NPPES database for address information, and physicians sometimes don't update their address ... ever. However, we do check this address against other sources and will override if certain criteria match among said sources.|
|3 months to 18 months||Our core dataset for referrals is on an 18 month lag, however we also examine the claims and where we are able to uncover additional relationships in more recent data (see Part A Medicare claims, above) we will add those relationships in.|
|Referrals||Commercial||1 month||Note that while we may have access to claims only one month old, these won't comprise all of the claims from that time period as most will take time to be adjudicated|
|Inpatient Claims||Commercial||1 month||Note that while we may have access to claims only one month old, these won't comprise all of the claims from that time period as most will take time to be adjudicated|
|Outpatient Claims||Commercial||1 month||Note that while we may have access to claims only one month old, these won't comprise all of the claims from that time period as most will take time to be adjudicated|
|Ambulatory Surgical Center||Commercial||1 month|