View the TRICARE Inpatient (ACUTE) Calculator Results

Use this procedure to view the TRICARE Inpatient (Acute) Calculator results.

  1. Access the TRICARE Inpatient Calculator (ACUTE) results.
    1. Select Go To > Government Payor Research > TRICARE > Inpatient Calculator. The TRICARE Inpatient Calculator Selection page opens.

      Note: If your facility offers only one type of TRICARE inpatient services, the system bypasses this selection page.

    2. Select Acute from the Type of PPS list and click Next. The Inpatient TRICARE Calculator (ACUTE) page opens.
    3. Select the calculation criteria and click Calculate. The TRICARE Inpatient Calculator Results (ACUTE) page opens. For more information about the calculation criteria, refer to Use the TRICARE Inpatient (ACUTE) Calculator.
  2. View the calculation results.
  3. To view additional details regarding the information on this page:

    Note: Click the Bill Type link to display the Billing Type Definition page. For more information, refer to Billing Type Definition.

  • New IPPS Calculator returns to a blank calculator page.
  • Recalculate TRI IPPS returns to the previous page.

The following table describes each of the fields on the TRICARE Inpatient Calculator (ACUTE) page.

Field

Description

Bill Type

Bill type.

Discharge Status

Patient’s destination upon discharge (home, LTC, and so on).

Reimb.

Reimbursement type.

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

DRG weight factor for each DRG.

Procedure Codes

Displays the procedure codes entered into the calculator.

Length of Stay

The length of stay for the claim, in days.

Bill Charges

Total billed charges for the product during the selected time period.

DRG Inlier Payment

Base payment for all TRICARE claims.

Short Stay Outlier Payment

Payment amount if stay is equal to or less than the Low Day Trim.

Outlier Payment

Total amount paid for extraordinarily high cost, in addition to the DRG payment.

Transfer Payment

Payment amount if UB has a transfer discharge status; in place of DRG Inlier payment

Pass-Through Payment

Total reimbursement for certain high-cost items like implants, high cost drugs and biologicals for which the actual or higher cost is passed through to the payor.

Blood Clotting Factor Payment

Payment amount if claim includes relevant codes.

Total Expected Reimbursement

Total expected reimbursement on the claim.

New Tech Add On

Displays the New Tech add on amount.

Operating VBP Adjustment

Displays the operating value base purchasing adjustment.

New Tech VBP Adjustment

Displays the New Tech value base purchasing adjustment.

Covid19 Adjusted

Indicates Yes or No if adjusted for COVID-19.