Updated research request forms and data security approval requirement effective 4/24/23
This variable is the sum of all the pass through per diem payment amounts (CLM_PASS_THRU_PER_DIEM_AMT from each claim) in the acute inpatient hospital setting for the year. Medicare payments are designed to include certain "pass-through" expenses such as capital- related costs, direct medical education costs, kidney acquisition costs for hospitals that are renal transplant centers, and bad debts. This variable is the sum of all the daily payments for pass-through expenses. It is not included in the Medicare Payment amount (ACUTE_MDCR_PMT). To determine the total Medicare payments for acute hospitalizations for the beneficiary, this field must be added to the total Medicare payment amount for acute inpatient hospitalizations.
This variable was new in 2010; it will always be null/missing in earlier files.
ACUTE_MDCR_PMT must be added to this field to obtain the total Medicare payments for the year.
Acute inpatient hospital claims are a subset of the claims in the IP data file consisting of data from both acute hospitals and critical access hospitals (CAH). These facilities are those where either the 3rd digit of the provider number (SAS variable PRVDR_NUM) = 0 or the 3rd and 4th digits of PRVDR_NUM = 13.
There are 2 cost/use categories from the IP data files: Acute and the OIP.
Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics” (see: http://www.medpac.gov/-documents-/payment-basics).
Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series” (see the list of MLN publications at: http://www.cms.gov/Outreach-andEducation/Medicare-Learning-Network-MLN/MLNProducts/MLN- Publications.html)
Source: CCW (derived)