The total submitted charges on the claim (sum of all line-level submitted charges, variable called LINE_SBMTD_CHRG_AMT)
Comments
The charges the provider submits may be different than the amount that Medicare or a secondary payer will allow for the claim - and this amount is also different than the actual Medicare or beneficiary paid amounts.
Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics” (see: http://www.medpac.gov/payment_basics.cfm).
The charges the provider submits may be different than the amount that Medicare or a secondary payer will allow for the claim - and this amount is also different than the actual Medicare or beneficiary paid amounts.
Medicare payments are described in detail in a series of Medicare Payment Advisory Commission (MedPAC) documents called “Payment Basics” (see: http://www.medpac.gov/payment_basics.cfm).
Also in the Medicare Learning Network (MLN) “Payment System Fact Sheet Series” (see: http://www.cms.gov/Outreach-and-Education/Medicare-Learning-NetworkMLN/MLNProducts/MLN-Publications.html)
Source: NCH QA Process