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Pass Through Per Diem Amount

CLM_INSTNL_PER_DIEM_AMT

THE MAXIMUM AMOUNT A PROVIDER CAN BE PAID FOR EACH DAY OF CARE. [HRMZ] FOR MEDICARE IP, THE AMOUNT OF THE ESTABLISHED REIMBURSABLE COSTS FOR THE CURRENT YEAR DIVIDED BY THE ESTIMATED MEDICARE DAYS FOR THE CURRENT YEAR (ALL PPS CLAIMS), AS CALCULATED BY THE FI AND REIMBURSEMENT STAFF. ITEMS REIMBURSED AS A PASS THROUGH INCLUDE CAPITAL-RELATED COSTS; DIRECT MEDICAL EDUCATION COSTS; KIDNEY ACQUISITION COSTS FOR HOSPITALS APPROVED AS RTCS; AND BAD DEBTS (PER PROVIDER REIMBURSEMENT MANUAL, PART 1, SECTION 2405.2) ** NOTE: PASS THROUGH ARE NOT INCLUDED IN THE CLAIM PAYMENT AMOUNT. [NCH, HRMZ]

Field Metadata

FHIR Resource
ExplanationOfBenefit
FHIRPath
ExplanationOfBenefit.adjudication.where(
category.coding.where(
system = 'https://bluebutton.cms.gov/fhir/CodeSystem/Adjudication' and
code = 'CLM_INSTNL_PER_DIEM_AMT'
).exists()
).amount.value
Coverage / Claim Type
  • Inpatient
  • SNF
Source View
V2_MDCR_CLM_INSTNL
Source Column
CLM_INSTNL_PER_DIEM_AMT
Sources
  • FISS
  • NCH
Profiles
  • CMS

Example

5

Mappings

CCLF
  • CCLFA.CLM_INSTNL_PER_DIEM_AMT
CCW
  • CLM_PASS_THRU_PER_DIEM_AMT
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