View the Medicare LTCH PPS Expected Reimbursement Detail

The information on the Expected Reimbursement Detail page for Medicare inpatient accounts is different from that of commercial inpatient accounts. If the Expected Reimbursement Detail is incomplete, click a Service Type link.

Note: Beginning on 10/01/2015, LTCH inpatient claims will be paid at either of the following rates:

The LTCH payment rate.
A blended rate of 50% of the site-neutral rate and 50% of the LTCH payment rate.

Field Descriptions – Medicare LTCH PPS

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare LTCH PPS claims. The fields are listed in the order in which they appear on the page.

Field	Description
Error Code	Reason for rejection or return, if applicable.
Total Blended Expected Reimbursement	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
Inpatient Deductible	The deductible amount on the claim. Deductible amounts are determined by the patient Point of Origin (FL15). If FL15 = 4 or D, there is no deductible. If the source is NOT another inpatient facility, the deductible is applied for each benefit period (60 days).
Inpatient Co-Payment	The co-payment amount on the claim. The amount is determined by the patient’s entire length of stay, including any patient days from a prior admission that is part of the same episode of care (when those days are reflected on the claim).
Sequestration Reduction	The 2% sequestration reduction on Medicare Inpatient claims for patients discharged on or after 04/01/2013. The reduction is applied to the Total Expected Payment after any applicable co-payment and deductible amounts are applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Payor Reimbursement	The reimbursement amount due to the payor after the deductible, co-payment, and sequestration reductions are applied.
Standard LTCH Reimbursement
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
DRG	Diagnosis Related Group. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2.
DRG Weight	The LTCH DRG weight factor established by Medicare for each DRG
Covered Days	Number of covered days
Covered Charges	Amount of charges covered by Medicare, Workers’ Compensation or TRICARE
Diagnosis Code Sequence	The sequence that the codes are listed on the UB92. The first code is labeled Principle.
Federal Payment	The portion of government payment under the “new,” perspective payment system. This is paid in conjunction with the Hospital-Specific Payment. For more information, refer to Hospital-specific Payment.
Hospital-Specific Payment	The portion of government payment under the “old,” cost-based payment system. This is paid in conjunction with the Federal Payment. This will be phased out in several years. For more information, refer to Hospital-specific Payment.
Outlier Payment	Total amount for extraordinarily high cost (cost outlier) for that service date
Full LTCH Expected	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data
50% of LTCH Expected	50% of the LTCH payment rate.
Site Neutral Reimbursement
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
DRG	Diagnosis Related Group. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2.
Acute DRG Weight	The Acute DRG weight factor established by Medicare for each DRG.
Covered Days	Number of covered days
Covered Charges	Amount of charges covered by Medicare, Workers’ Compensation or TRICARE
IPPS Comparable	The Acute MSDRG payment amount.
Estimated Cost	100% of cost
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
50% of Site Neutral	50% of the site-neutral rate.