Sometimes when you use the filters to narrow the focus of a table to a specific county, the county of interest doesn't appear in the county selection section of the location filter. Why would a county not be represented in this filter? Or a city, of ZIP Code? The really short answer is; there is no data from the Medicare claims for that county for the provider type you are looking for. For the full answer, read on.
This same issue applies to cities, ZIP codes and, in rare cases, states.
The CMS database includes two addresses for each NPI; a mailing address and a primary practice address. In Marketscape, we organize providers using the primary practice address. The information we find in the primary practice address determines the association for the following filters; city, state, county, and ZIP code.
So, why is the county I'm looking for missing?
The different choices available in the filters are populated based on what we compile from the NPPES NPI database. If we don't "find" data to trigger a specific county for inclusion in the search results, the county will not show up in the filter's inclusion list. There are two possibilities:
For these examples, let's assume that you have actually been to the physical location of the missing physician, facility, or agency.
1) The address in the CMS database has not been updated. If the NPI "owner" doesn't update the NPPES NPI directory, the primary practice address might not match the actual physical location. In these cases, the physician or organization could be found in a different county, city, ZIP code, or even state from the actual physical location.
As an example, we were looking for a hospice with a physical address in a small county in Michigan. We could not find it by filtering for the county. When we searched the NPPES database using the known NPI, we discovered that the mailing address for the agency was in a neighboring county and the primary practice address was a different address in another county.
2) The physician or organization didn't submit any Medicare claims during the reporting period from which the data was collected. If an entity didn't submit any claims, it will not appear in the Excel Health data.
As it turned out, the hospice mentioned above was not only listed in a different county, it had not submitted any Medicare claims during the reporting period anyway. In this case, there were no other hospices in that county. As a result, there was nothing in the data to trigger adding that county in the filters.
What happened to ZIP Code 19113?
Another recent example stumped us. There is no data in the Trella Health data for 19113. Billions of claims? Where did this ZIP Code go? This ZIP code is for the little community of Essington, Pennsylvania, situated at the end of the runway for Philadelphia International airport. There are a couple hundred homes there, but not one medical organization or physician. As a result, the ZIP Code doesn't show up in our data.
Now you might ask, what about in Patient demographics, surely some Medicare patients dwell in the shadow of all those planes? Remember that we can't reveal any patient counts less than eleven. And, as ZIP Code requirements are becoming more restrictive, it is increasingly unlikely that some ZIP codes will be visible in patient demographics.
As a further challenge - some facilities submit claims under an "umbrella" NPI. In that case, the claims for the location of service will fall under the location of the NPI that submits the claim. for information of providers that bill under another NPI.
What can I do?
The goal is to track down the physician or organization. Solutions include:
1) Start with a Google search to confirm the location of the facility. It is possible that you will find that the organization has multiple associated addresses which might be a helpful clue. You can also use the NPPES NPI Registry to find the physician or organization to identify the primary practice address. The link is: https://npiregistry.cms.hhs.gov/
2) Send in a support request to Support@ExcelHealthGroup.com and we will help you to find what you are looking for.