Provider Attribution in Medicare: Challenges and Solutions.

ABSTRACT:

Objective

To enhance National Provider Identifier (NPI) and specialty information available in Medicare Advantage (MA) encounter data and use the enhanced data to evaluate methods for retrospective attribution of the patient's usual clinician, comparing results across MA and Traditional Medicare (TM) populations.

Study setting and design

We fill in missing clinician identifiers and specialty codes in MA encounter data using Centers for Medicare and Medicaid Services (CMS) and publicly available provider datasets. We attributed patients to the usual clinician using 16 methodological options, comparing the performance of these attribution methods in MA and TM.

Data sources and analytic sample

We used a 20% sample of MA encounter data and TM claims data for 2016-2022, in

SUBMITTER: Carlin CS 

PROVIDER: S-EPMC12857508 | biostudies-literature | 2026 Feb

REPOSITORIES: biostudies-literature