Back to top
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

Source: NCH

This field is new in January 2020. This field only applies to Part A claims. For participating hospitals within the PA model all inpatient and outpatient services (facility/technical services) are considered a part of the model/global budget services. Basically, all the services for participating hospitals would be global except for CAH Method II (where the bill type is 85X) claims lines with revenue codes 096x, 097x or 098x. The CAH Method II professional services (REV codes 096x, 097x or 098x) process as they do today, they have nothing to do with the model.