Claim Model Reimbursement Amount

This variable is contained in the following files:

Home Health Agency (Fee-for-Service) Hospice (Fee-for-Service) Inpatient (Fee-for-Service) Outpatient (Fee-for-Service) Skilled Nursing Facility (Fee-for-Service)

SAS Name

CLM_MODEL_REIMBRSMT_AMT

This field contains the "Net Reimbursement Amount" of what Medicare would have paid for Global Budget Services from a hospital participating in the particular model. If the claim only includes global services, the reimbursement amount (CLM_PMT_AMT) will reflect $0 (zero). If the claim includes global services and non-global services, the reimbursement amount will reflect the amount Medicare actually paid for the non-global services.

Comments

This field is derived by accumulating the Claim Model Reimbursement Amount (CLM-MODELREIMBRSMT-AMT) that is present on any of the claim records included in the stay (i.e., sum of the CLMMODEL-REIMBRSMT-AMT reported on the claims that comprised the stay).

NOTE: This field will be used with future models and not just the Pennsylvania Rural Health Model (PARHM) (CR11355). A demo code (CLM_DEMO_ID_NUM) will be assigned for future models. CLM_RLT_COND_CD = M6 and CLM_VAL_CD = Q4 have been created to identify the PARH model.

This field is new in 2019.

Source: NCH