Back to top
This variable is contained in the following files: Inpatient (Fee-for-Service)
Short SAS Name
CLM_MODEL_4_READMSN_IND_CD
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.

Comments

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

CodeCode 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