View the New York Medicaid IP Expected Reimbursement Detail (APR-DRG)

Use the following procedure to view the New York Medicaid Expected Reimbursement Detail for inpatient accounts using APR-DRG.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

Field Descriptions - New York Medicaid IP APR-DRG Accounts

The following table describes the fields on the Expected Reimbursement Detail page for New York Medicaid IP accounts using APR-DRG.

Field	Description
Alternate Level of Care Days	The number of alternate level of care days included in the Service From and Service To dates
Alternate Level of Care Per Diem	The calculated per diem rate for inpatient care that does not include the days of acute care.
Capital Cost Per Day	Flat rate added to the operating blended cost rate per day to determine the inlier case payment
Capital Cost Per Discharge	Flat rate added to the operating blended cost rate per discharge to determine the inlier case payment
Cost to Charge Ratio	The facility-specific inpatient charges by revenue center converted to costs using a cost-to-charge ratio (RCC) for each revenue center. The corresponding RCCs are derived from your facility’s cost report.
Covered Charges	Amount of charges covered by Medicare, Workers’ Compensation or TRICARE
Covered Days	Number of covered days
DME Per Discharge Add-On	The Direct Medical Education per discharge add-on value. This value is not severity adjusted. The add-on value is applied to the case payment rate after application of the APR-DRG weight for teaching hospitals.
Effective Date	Effective Date
Error Code	Reason for rejection or return, if applicable
Inlier Case Payment	Calculated by multiplying your facility’s specific operating blended cost per case rate by the DRG weight and then adding your facility’s specific capital cost per case
Medicaid/Managed Medicaid Statewide Operating Base Rate for Adjusted Facility Wage Costs	The statewide operating base rate adjusted for institution-specific wage costs for Medicaid and Medicaid Managed Care. The column heading indicates whether the Medicaid or Managed Medicaid base rate was used to calculate the reimbursement. The Managed Medicaid base rate is used when the APR-DRG with Managed Care check box is selected on the Medicaid - Facility reimbursement tool. If this check box is not selected, the Medicaid base rate is used. For more information about this reimbursement tool, refer to Medicaid - Facility.
Medicaid Psych Operating Base Rate	The statewide operating base rate adjusted for institution-specific wage costs for Medicaid and Medicaid Managed Care Psych claims. The column heading indicates Psych base rate is used to calculate the reimbursement.
Medicaid Psych Non-Operating Base Rate	The statewide Non-operating base rate adjusted for institution-specific wage costs for Medicaid and Medicaid Managed Care Psych claims. The column heading indicates Psych Non-Operating base rate is used to calculate the reimbursement.
Outlier Amount	Total amount for extraordinarily high cost (cost outlier)
Psych APR-DRG	All Patient Refined Diagnosis Related Group for psych services.
Psych APR-DRG Weight	APR-DRG weight factor is calculated for each Psych APR-DRG and the weight value from the APR-DRG table is not used. The patient age factor based on age of patient, co-morbidity factor, and length of stay factor are used to determine the actual Psych APR-DRG weight.
Provider Number	Provider Number
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
Severity	Severity of Illness code submitted with the APR-DRG that indicates the severity of illness and risk of mortality. Options include the following: 1 – Minor 2 – Moderate 3 – Major 4 – Severe
State ID	The two-letter state identifier.
Total Reimbursement	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Transfer Amount	Transfer Amount