Remittance Advice Detail – Rehab Inpatient Medicare Accounts

On the Remittance Advice Detail page, rehab inpatient accounts are shown differently than other accounts.

Field Descriptions—Rehab Inpatient Medicare Accounts

The following table describes the fields on the Remittance Advice Detail page for rehab inpatient Medicare accounts (applicable only if FinThrive reprices inpatient Medicare claims for your facility).

Field

Description

CMG

Case Mix Group code

Covered Charges

Covered charges

Covered Days

Number of covered days

Outlier

Reimbursement based on operating (nursing, ancillary and support) costs

Payment

Total expected Medicare reimbursement, minus the outlier cost

Payment Codes

Used to explain the payment of the account; defined the Remittance Payment Codes table

Reimbursement

Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)

Remittance Payment Codes

Explanation of the remittance payment codes used in the Payment Codes column

Total 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

Weight

CMG weight, which reflects the relative complexity of the rehab patient's care; multiplied by the conversion factor to determine the payment on the case