The Medicare Provider Profile page shows the Medicare services provided by your facility, along with the values and effective dates of Medicare reimbursement calculations. You can also enter a DRG/CMG code to add the lookup table for that code to the display.
Procedure
- To access the Medicare Provider Profile page, select Go To > Government Payor Research > Medicare > Provider Profile.
- Enter a date in the Effective Date field if you want to view provider profile information for an effective date other than today.
- Enter a DRG or CMG code in the DRG/CMG field to view provider profile information specific to the entered code.
Note: Leave this field blank to view all provider profile information for the selected effective date
- Click Display Profile. The Medicare Provider Profile includes the following sections displayed vary based on the criteria selected:
- Inpatient Acute (IPPS - DRGs)
- Outpatient Acute (OPPS - APC & Fee Schedule)
- Reserve Report Factors
- IRF (IRF PPS - CMGs)
- Rehab
- Psych (IPF PPS)
- SNF (SNF PPS)
- LTCH (LTC DRGs)
- ESRD/ASC
- Hospice
Note: To clear the results and return to original Medicare Provider Profile page, click Reset.
- Review your Medicare Provider Profile information.
- To view additional details regarding the information on this page:
- Click History for an individual item on this page to view the historical changes to that value.
- Click the DRG/CMG link in the DRG/CMG Lookup section. The DRG/CMG Description page opens. For more information, refer to View Lookup Table Descriptions.
Field Descriptions
The following table describes each of the fields on the Medicare Provider Profile page.
|
Field |
Description |
|
Display History |
Click History to view the historical changes to a specific value |
|
DRG/CMG |
Diagnosis Related Group or Case Mix Group code |
|
Item |
Specific line item |
|
NPI(s) |
Facility’s ten-digit National Provider Identification (NPI) number required on all claims |
|
Provider Number(s)/NPI |
Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims |
|
Value |
Value of the line item |
|
Selection Criteria |
|
|
DRG/CMG |
Diagnosis Related Group or Case Mix Group code |
|
Effective Date |
Date on which the selected profile went into effect |
|
NPI(s) |
Facility’s ten-digit National Provider Identification (NPI) number required on all claims |
|
Provider Number(s)/NPI |
Provider’s tax ID number or ten-digit National Provider Identification (NPI) number required on all claims |
|
Profile Sections (i. e. Inpatient Acute or Outpatient Acute) |
|
|
Item |
Specific line item and varies based on the criteria selected. Note: The Outpatient Wage Index items displays for Skilled Nursing Facility (SNF), Rehab, Psych, and Long Term Care Hospital (LTCH). |
|
Value |
Value of the line item |
|
Effective Date |
Date on which the selected item went into effect |
|
Display History |
Click History to view the history of a specific item. |