The carrier claims data will contain two payment amount fields at the line item level that appear to be very similar. These variables are the "Line NCH Payment Amount" (LINEPMT) and the "Line Provider Payment Amount" (LPRVPMT). The LINEPMT field is the amount that Medicare is responsible for reimbursing for the line item. The LPRVPMT is the amount that
Carrier LDS KnowledgeBase Articles
Claims for ambulance services are found in both the Carrier and the Outpatient claims data. The Ambulance Fee Schedule provides the Healthcare Common Procedure Code System (HCPCS) that identify the services.
Background: Although ambulatory surgical centers (ASCs) perform surgeries that could also be performed in a hospital outpatient department, how they bill Medicare for these surgeries and the amount they are reimbursed for these surgeries differs from those that are performed in a hospital outpatient department.
There are two types of providers that are allowed to bill Medicare for outpatient-based surgeries:
Please note that the information below applies to the claim-level files, but not to the stay-level file (the LDS MedPAR).