• A new spreadsheet reveals more about what research data CMS withholds

    Previously, I posted a spreadsheet of codes that I believed CMS was using to select Medicare and Medicaid claims for removal from research data. Today, a colleague sent me more details, in another spreadsheet obtained from General Dynamics Information Technology, which, I’m told, they characterized as “a CMS approved list based off of conversations had with the SAMHSA legal staff.”

    I have not digested the full spreadsheet. (Actually, it’s a workbook with seven tabs.) Here’s some of what’s on the first tab, with my bold added:

    If no criteria met, then SAMHSA suppress code = 0.
    If any treatment code criteria found or primary DGNS [diagnosis] found, then SAMHSA suppress code = 1.
    If any treatment code criteria found or any DGNS found, then SAMHSA suppress code = 2.

    Option1 (Conservative): Suppress records with SAMHSA suppress code in(1,2).
    Option 2 (Less Suppression): Suppress records with SAMHSA suppress code = 1.

    In general, we used the conservative option when identifying substance abuse claims for suppression. That is, we exclude the claim for any treatment code criteria found, or primary diagnosis code found, or any diagnosis code found in the extract files of interest.

    So, now you know. I’ve opened up comments to this post (for one week) so folks who go over the spreadsheets can weigh in on what they’re seeing, what they think it means or implies, and ask relevant questions.

    @afrakt

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    • It seems that complying with Part 2 for SAMHSA means protecting (withholding) records of those treated at “federally assisted alcohol or drug abuse program”. But certainly some of these claims are for care at other facilities–yet it seems like CMS is removing ALL claims based on codes in spreadsheet, regardless of the facility where these services are provided. Am I misunderstanding or missed a tab maybe?