ResDAC is currently experiencing a high volume of requests, which may delay response and processing times. We are working to address the backlog as quickly as possible and appreciate your patience.
The Medicare claim payment amount.
For hospital services, this amount does not include the claim pass-through per diem payments made by Medicare. To obtain the total amount paid by Medicare for the claim, the pass-through amount (which is the daily per diem amount) must be multiplied by the number of Medicare-covered days (e.g., multiply the CLM_PASS_THRU_PER_DIEM_AMT by the CLM_UTLZTN_DAY_CNT), and then added to the claim payment amount (this field).
For non-hospital services (SNF, home health, hospice, and hospital outpatient) and for other non-institutional services (carrier and DME), this variable equals the total actual Medicare payment amount, and pass-through amounts do not apply.
For Part B non-institutional services (carrier and DME), this variable equals the sum of all the line item-level Medicare payments (variable called the LINE_NCH_PMT_AMT).
Source: NCH
Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called "Payment Basics”.
Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series”.