TRICARE Inpatient (IP) Tab

To calculate a TRICARE IP claim at 100% of the Federal Regulation Rates, use the default settings.

Note: Refer to the contract to determine the options to select and the values to enter.

Field Descriptions

The following table describes the fields on the IP tab of the TRICARE node.

Field	Description
Acute
DRG Amount	Percentage of DRG to use When a DRG Amount percentage override is defined, the DRG amount is reduced amount after the total DRG calculation. When a DRG Amount percentage override is NOT defined, the DRG amount is calculated at 100% of the expected amount.
IDME	Percentage of IDME to use
Override Blood Products	Provides the option to override the reimbursement percentage for blood products (revenue codes 380-390)
Override Transplant Donor	Provides the option to override transplant donor charges by a specified percentage
Override Amount	Provides the option to enter the specific reduction of the short stay outlier or cost outlier separate from the DRG reduction.
SNF
Per Diem	Percentage of SNF RUG to use
Rehab
Override Rehab % of charges	Percentage of charges
Apply Sequestration (on or after 10/1/2018)	Provides the option to apply the 2% Medicare sequestration reduction to that contract. Note: This option does not affect the calculation of deductible or co-payment amounts.
SCH
Price SCH as Acute	Provides the option for SCH facilities to price Inpatient Acute accounts using Acute DRG calculations. Enabling this check box overrides the facility type setup in the system and prices SCH IP Acute accounts as IP Acute.
LTCH
Use Medicare rules	Follow the Medicare rules.
Site Neutral Reimbursement	When selected, the LTCH Site Neutral pricing rules are applied to the contract.
Extend Blend Logic Beyond 9/30/2017	When selected, the blend logic is extended beyond 9/30/2018.
Bypass Ventilator Restriction	When selected, the LTCH Ventilator Restriction Rules are bypassed for claims with procedure code 5A1955Z (96 hours of Ventilator) .
Apply Sequestration	Provides the option to apply the 2% Medicare sequestration reduction to that contract. Note: This option does not affect the calculation of deductible or co-payment amounts.
Psych
Per Diem	Percentage of per diem charges
Global
Truncate (do not round) total	Provides the option to truncate the total. For example if a total is 100.85, it is truncated to 100. If left unchecked, the total will round to 101.
Do not consume units	Provides the option not to consume units. This is used for contract carve outs.
Do not consume charges	Provides the option not to consume charges. This is used for contract carve outs.