View Hospital 1500 Claims Expected Reimbursement Details

The Expected Reimbursement Detail page displays the expected reimbursement calculations for the applicable reimbursement for a selected invoice.

Procedure

Access the Expected Reimbursement Details page. For more information, refer to View the Expected Reimbursement Details.
Click an REIM link in the View column. The Expected Reimbursement Detail page opens.

View the expected reimbursement details for the selected invoice. This page is divided into the following sections:

Section	Description
Patient Summary	Summarizes the patient details for this invoice, such as invoice number, patient name and address, insured ID, and so on. To hide the Patient Summary section and provide more room on the page for the other sections to display, click Hide Patient Summary. To show the Patient Summary section when it is hidden, click Show Patient Summary.
Provider Summary	Summarizes the provider details for this invoice, such as the provider name, federal tax ID, payor name, and physician information. To hide the Provider Summary section and provide more room on the page for the other sections to display, click Hide Provider Summary. To show the Provider Summary section when it is hidden, click Show Provider Summary.
Reprice Summary	Summarizes the details of the reprice for this invoice, such as the billed charges, expected discount, actual discount, write-offs, adjustments, expected payment, and so on. To hide the Reprice Summary section and provide more room on the page for the other sections to display, click Hide Reprice Summary. To show the Reprice Summary section when it is hidden, click Show Reprice Summary.
Expected Reimbursement Details	Displays the details of the expected reimbursement calculation for each line item on the invoice. The columns between the Charged Amount column and the Expected Reimbursement column in the Expected Reimbursement Details section represent the reimbursement tools used to calculate the expected reimbursement. For example, RBRVS, Fee Schedule, Modifier Percentage, and so on. Each reimbursement tool is represented by a column, and the columns appear in same order, from left to right, as the reimbursement tools in the contract profile. Each value in a reimbursement tool column is a link that displays the details of the calculation that tool performed for this invoice. You can either click the link or hover over it to view the calculation details. To view a description of the modifier or place of service used, click a link in the Modifier(s) or Place of Service columns. To view the lookup tables used for a specific line item, click a link in the Provider Specialty Percentage or Fee Schedules columns.
Geographical Pricing Cost Index (GPCI)	The GPCI table refines the expected reimbursement calculation to a specific carrier and locality. The information displayed in this section is primarily informational and may not have been used in the actual calculation. Note: This section defaults to the GPCI table that corresponds to the zip code for the place of service, but can be overridden within the contract profile.
Relative Value Units (RVU)	Displays the Medicare RVU details defined in the contract profile. The information displayed in this section is primarily informational and may not have been used in the actual calculation. Note: Many of the values in the Relative Value Units (RVU) section are also links that display additional details.
Geographical Pricing Cost Index (GPCI)	The GPCI table refines the expected reimbursement calculation to a specific carrier and locality. The information displayed in this section is primarily informational and may not have been used in the actual calculation. This section defaults to the GPCI table that corresponds to the zip code for the place of service, but can be overridden within the contract profile. If your facility sends RA data to FinThrive, GPCI information displays on the GPCI /RVU Detail page.
Relative Value Units (RVU)	Displays the Medicare RVU details defined in the contract profile. The information displayed in this section is primarily informational and may not have been used in the actual calculation. Many of the values in the Relative Value Units (RVU) section are also links that display additional details. If your facility sends RA data to FinThrive, RVU information displays on the GPCI /RVU Detail page.

Optionally, you can perform the following actions:
- To save your Show/Hide selections so that the sections that are hidden default to hidden and the sections that are shown default to shown when you access this page in the future, click Save Settings.
- To generate a resubmission package for this invoice, click Generate Resubmission Package. For more information about generating a resubmission package, refer to Generate a Resubmission Package.
- To generate a patient balance package for this invoice, click Generate Patient Balance Package. For more information about generating a patient balance package, refer to Generate Patient Balance Package.
- To categorize or flag an invoice, click Flag Invoice.
- To view GPCI or RVU details for the invoice, click View GPCI / RVU Detail.
- To research another invoice, type the invoice number in the Invoice Number field and click Display Invoice.

Field Descriptions

The following table explains information on the page for accounts. The fields are listed in order by section.

Note: The columns between the Charged Amount column and the Expected Reimbursement column, in the Expected Reimbursement Details section, represent the reimbursement tools used to calculate the expected reimbursement, for example, RBRVS, Fee Schedule, Modifier Percentage, and so on. Each reimbursement tool is represented by a column, and the columns appear in same order, from left to right, as the reimbursement tools in the contract profile.

Field	Description
Patient Summary
Patient Invoice Number	Unique number that identifies an invoice within your clinic
Patient Name	The name of the patient
Patient Date of Birth	Patient birth date
Insured ID	ID number of the insured individual
Insured Name	Name of the insured
Group Number	Insurance group number
Provider Summary
Provider	Name of the physician clinic
Federal Tax ID	Federal Tax ID of the provider
Payor	Name of the insurance company paying the claim
Physician Name	Name of the rendering or supervising physician
Physician Number	ID number of the rendering or supervising physician
Reprice Summary
Billed Charges	Total charges for the invoice
Expected Discount	The expected discount amount
Actual Discount (Insurance)	Total insurance adjustments for all accounts; Explanation of Benefits (EOB) write-off
Other Contractual Write-offs	Other insurance adjustments not included in the discount variance
Total Contractual Write-offs	Total insurance adjustments not included in the discount variance
Discount Variance	Expected Discount minus the Actual Discount
Miscellaneous	Non-billable amounts
Non-Contractual/Other Adjustments	Other, non-insurance adjustments
Total Expected Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the FinThrive system and the repriced claims data
Expected Insurance Payment	Billed charges minus the expected discount, minus the expected patient liability amount
Expected Patient Liability	Portion the patient is expected to pay. This column only displays if there are GA or GY modifiers for the invoice.
Patient Liability	The amount the patient is responsible for paying on the account.
Insurance Payment	The amount paid by the insurance company
Patient Payment	The amount paid by the patient
Payment Variance	Total Expected Reimbursement minus the actual payment. If the Patient Liability is known, it is calculated as Expected Payment - Patient Liability - Insurance Payment. If Patient Liability is unknown, it is calculated as Expected Payment - (Insurance Payment + Patient Payment)
Expected Reimbursement Details
No.	Sequential reference number of the item
Date of Service	Date the service was rendered
Place of Service	Indicates the location where the service was performed. This field defaults to 11 - Office.
Type of Service	Type of service for the calculation. For most contracts, the type of service does not impact the calculation. The most common use of this field is to reprice a specific CPT code, such as a surgical CPT code, as an anesthesia code rather than a surgical code.
CPT/HCPS Code	The procedure code associated with the line item. This field provides a link to additional information about the value in this field. Click the link to view basic information about the code. KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code. Note: You must be a KnowledgeSource subscriber to view ICD-10 code information.
Modifiers	The modifier values associated with the line item. This field provides a link to additional information about the value in this field. Click the link to view basic information about the code. KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code. Note: You must be a KnowledgeSource subscriber to view ICD-10 code information.
Units	Number of units of the procedure code
Charged Amount	Billed amount
CMS Drug Fee Schedule	The reimbursement value based on the national Medicare drug fee schedule.
CMS Lab Fee Schedule	The reimbursement value based on the national Medicare lab fee schedule.
CMS MPFS Node	The reimbursement amount based on the percentage of the fee schedule, effective dates, and other terms specified in the MPFS node. Note: Click an amount in blue text to view a description of the MPFS node option applied for that line item.
CCI Edits Pro	The reimbursement amount for eligible procedures in the CCI schedule. Note: This column is displayed only if the contract profile is defined to flag and edit reimbursements for eligible procedures in the CCI schedule. For more information, refer to CCI Edits Pro.
Expected Insurance Payment	Billed charges minus the expected discount, minus the expected patient liability amount
Geographical Pricing Cost Index (GPCI)
Carrier/Locality	The specific carrier/locality code used to apply a Geographical Pricing Cost Index (GPCI)
Location	Location where the service was performed.
GPCI Work	A weighting for the cost of employing a person in the defined carrier/locality
GPCI PE	A weighting for the practice expense of owning land/property in the defined carrier/locality
GPCI MP	A weighting for the cost of malpractice in the defined carrier/locality
Year	The effective date year used to determine the GPCI values
Relative Value Units (RVU)
CPT/HCPCS	The procedure code associated with the line item. This field provides a link to additional information about the value in this field. Click the link to view basic information about the code. KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code. Note: You must be a KnowledgeSource subscriber to view ICD-10 code information.
MOD	The modifier values applied to the procedure code. This field provides a link to additional information about the value in this field. Click the link to view basic information about the code. KnowledgeSource subscribers can log in to KnowledgeSource to view detailed information about the code. Note: You must be a KnowledgeSource subscriber to view ICD-10 code information.
STATUS CODE	Status of the code under the full fee schedule
FACILITY TOTAL RVU	The facility Relative Value Units (RVU) values for each CPT code, which equals the sum of the following relative value units: WORK PE RVU FACILITY PE RVU MP RVU
NON FACILITY TOTAL RVU	The non-facility Relative Value Units (RVU) values for each CPT code, which equals the sum of the following relative value units: WORK PE RVU NON-FAC PE RVU MP RVU
WORK RVU	The unit value for the physician work relative value unit.
NON-FAC PE RVU	Fee schedule amount for the non-facility setting
FACILITY PE RVU	Fee schedule amount for the facility setting.
MP RVU	The unit value for the malpractice expense relative value unit
PRE OP	The percentage (in decimal format) for the preoperative portion of the global package.
INTRA OP	The percentage (in decimal format) for the intra-operative portion of the global package, including post-operative work in the hospital
POST OP	The percentage (in decimal format) for the postoperative portion of the global package that is provided in the office after discharge from the hospital
MULT PROC	Indicates which payment adjustment rule for multiple procedures applies. The value in this column is a link that displays a description of the value.
BILAT SURG	Indicator for services subject to a payment adjustment. The value in this column is a link that displays a description of the value.
ASST SURG	Indicator for services where an assistant at surgery is never paid for, per the Medicare Carriers Manual. The value in this column is a link that displays a description of the value.
CO-SURG	Indicator of services for which two surgeons, each in a different specialty, may be paid. The value in this column is a link that displays a description of the value.
TEAM SURG	Indicator of services for which team surgeons may be paid. The value in this column is a link that displays a description of the value.
ENDO BASE	Endoscopic base code for each code with a multiple surgery indicator of 3.
CONV FACTOR	The multiplier that transforms relative values into payment amounts
EFFECTIVE DATE	Effective date of the CMS RVUs displayed, which is based on the date of service