View Preliminary Expected Reimbursement
Preliminary Expected Reimbursement is an optional feature that your facility might or might not possess. If it does, you can use this procedure to view preliminary expected reimbursement for account research on in-house and discharged patients, assuming they are not final-billed.
Procedure
- Access the Preliminary Expected Reimbursement page.
- Select Go To > Account Research > Preliminary Exp. Reimb. The Preliminary Expected Reimbursement page opens.
- Specify selection criteria and click Display Results. The Preliminary Expected Reimbursement page with results opens.
- View the list of accounts with preliminary expected reimbursement.
- Click a link in the Patient Number column to display the supplemental billing history for that account.
- For more information about supplemental billing, refer to Specify Supplemental Billing Account Research Criteria and View Supplemental Billing History by Account.
- Click a link in the DRG column to display the DRG Description platform more information, refer to View Lookup Table Descriptions.
- To export the information to Microsoft Excel® or a text file:
- Select either Microsoft Excel or Text File from the Export To list.
- Select Microsoft Excel to open Excel. You can then work with the data in Excel.
- Select Text File to save the data as plain text (with no formatting). Typically, you select this option if Excel is unavailable on your computer or you have Excel version’97 or older.
- Click Export.
- Select either Microsoft Excel or Text File from the Export To list.
Field Descriptions
The following table describes the fields on the Preliminary Expected Reimbursement results page.
|
Field |
Description |
|
Actual Discount |
Total insurance adjustments for all accounts; Explanation of Benefits (EOB) write-off |
|
Admit Date |
Date of admission for the account |
|
Bill Date |
Bill date |
|
CM |
Case Mix Group |
|
CPT4 |
CPT4 code |
|
DIAG |
ICD-10 Diagnosis Code |
|
Discharge Date |
Discharge date (if applicable) |
|
DRG |
Diagnosis Related Group code. If the DRG was submitted with a Severity of Illness code, it displays as DRG-Severity Code, for example, 001-2. |
|
Expected Discount |
Billed Charges minus non-covered charges, minus Total Expected Reimbursement |
|
Expected Reim |
Preliminary expected reimbursement |
|
Financial Class |
Financial class code |
|
HSVC |
Hospital service code |
|
ICD_PROD |
ICD-10 code |
|
LOS |
Length of Stay, in days |
|
Msg Code |
Repricing message code (a link to the message code description) |
|
Other Adj |
Adjustments other than contract adjustments |
|
Patient Number |
Patient account number (for UB claims) or insured ID (for CMS-1500 claims) |
|
Patient Type |
Patient type assigned to the account: Inpatient/Outpatient |
|
Payor Code |
Payor code associated with the product |
|
Prod Match |
Product match |
|
Total Charges |
Total charges for the account |