Revenue Center Model Reimbursement Amount

This variable is contained in the following files:

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

SAS Name

RC_MODEL_REIMBRSMT_AMT

This field is used to identify the “net reimbursement amount” of what Medicare would have paid for the global budget service reflected at the line level, from a hospital participating in the particular model.

Comments

This field is derived by accumulating the Revenue Center Model Reimbursement Amount (REV-CNTRMODEL-AMT) that is present on any line item on all claim records included in the stay (i.e., sum of the REV-CNTR-MODEL-AMT reported on the claims that comprised the stay).

For the participating hospitals in the PA model all inpatient and outpatient services (Facility/Technical Services) are considered part of the Model/Global Budget Services. Basically, all the services for a participating hospital would be global except for CAH Method II (85X) claim lines with revenue center codes 096X, 097X, and 098X. The CAH Method II professional services (rev codes 096X, 097X, and 098X) process as they do today, they have nothing to do with the model.

This field is first available in 2019.

Source: NCH