Updated research request forms and data security approval requirement effective 4/24/23
This variable is contained in the following files:
SAS Name
CLM_MODEL_4_READMSN_IND_CD
This field identifies the method of payment of a claim billed within 30 days of a Model 4 Bundled Payments for Care Improvement (BPCI) admission.
| Code | Code value |
|---|---|
| 1 | claim is related readmission to a Model 4 BPCI claim and shall pay IME, DSH, and Capital Only. |
| 2 | two Model 4 BPCI claims within 30 days of each other, first claim in episode shall process as it would in the absence of Model 4 BPCI. |
| 3 | two Model 4 BPCI claims within 30 days of each other, this is the second claim in the episode and paid as Model 4. |
| Null/missing | not a BPCI claim |
Bundling payment for services that patients receive across a single episode of care, such as heart bypass surgery or a hip replacement, is one way to encourage doctors, hospitals and other health care providers to work together to better coordinate care for patients. Under the Model 4 BPCI pilot, CMS will reimburse qualified acute care hospitals a blended payment for hospital inpatient care and physician services connected with a single episode of care. This will occur in association with inpatient hospital claims that the BPCI participating hospital will bill to their jurisdictional A/B MAC as type of bill 11X claims.
Source: NCH