Please clarify the usage of the 835 2100 Loop AMT, where AMT01=DY Per Day Limit. Is the ‘per day limit’ applicable to only a Per Diem reimbursement methodology or is it applicable for any type of reimbursement methodology that establishes a specific Per Day Limit? For example, when the payment methodology is on a Per Diem basis, we assume the daily rate would be reported in the AMT? If the payment methodology is a DRG and outlier days are paid, would the dollar amount limit for the outlier days also be reported in the AMT?
The 005010X221A1 Technical Report Type 3 (TR3) does not explicitly address this question. Since the TR3 does not restrict the DY qualifier to a particular payment methodology, it is compliant with the TR3 to report the dollar amount limit for outlier days.