This variable equals the total amount that Medicare paid for a particular claim, revenue center record, claim line, or service category. The exact method used to derive the variable differs based on the nature of the original claim, but the meaning of the variable is the same. Part A Claim File: For services provided by any type of hospital, this variable equals the sum of the claim payment amount and the claim pass-through payment amount on the original claim. Medicare uses pass-through payments to provide funding for direct graduate medical education, coverage of some bad debt, and other purposes. The amounts on the claim are interim payments; the final amount is determined when hospitals file their cost reports. For non-hospital services (SNF, home health, and hospice), this variable equals the claim payment amount (CLM_PMT_AMT).
Part B Institutional Revenue Center File: This variable equals the revenue line payment amount (REV_CNTR_PRVDR_PMT_AMT). Can add ACTUAL_PMT for each revenue center record on the claim to get the total payment amount for the claim, which is already summed in the GVDB and called the CLM_PMT variable. Part B Non-Institutional Claim Line File: This variable equals the line payment amount (LINE_NCH_PMT_AMT) from the original claim. Can add up the line-level payments for a claim to get the total amount that Medicare paid for the claim. Medicare FFS beneficiaries limited to those who (a) have no months of HMO enrollment and (b) have both Part A and Part B for whatever portion of the year that they are covered by FFS Medicare (i.e., they have no months of A-only or B-only coverage)..