View the Medicare Home Health Expected Reimbursement Detail

Use the following procedure to view the Expected Reimbursement Detail for a Medicare home health account.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

Field Descriptions – Medicare Home Health

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare home health accounts. The fields are listed in alphabetical order.

Field	Description
Billed Units	Number of units billed.
Charges	Total amount billed by the provider.
Claim Disposition	Disposition code for claim level.
Claim Error	Error code for the claim level.
CPT/HCPCS Codes & Modifiers	Associated CPT or HCPCS codes and modifiers.
Expected Base Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data.
Fee Schedule Payments	Total reimbursement from a fee schedule.
HIPPS Code	Health Insurance Prospective Payment System (HIPPS) code.
Line Item Date of Service (LIDOS)	Dates the service was rendered.
Message & Error Codes	Reason for rejection or return, if applicable.
NRS Payment	Case-mix adjusted payment for non-routine supplies.
Output HIPPS Code	Health Insurance Prospective Payment System (HIPPS) code based on clinical and functional severity levels and the number of therapy visits. This is the code used for pricing the claim.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs).
Revenue Code	Revenue code.
Total Claim Outlier Payments	Total amount for extraordinarily high cost (cost outlier) for that service date.
Total Deductible - RA, only	The total deductible imported or retrieved from the Remittance Advice.
Total Medicare Payment	Total Medicare payment.
Total Patient Responsibility	Patient co-payment, as stipulated by the rules.
Total Payment	The total Medicare and patient payments posted to the account, as defined in the data.
Total Payments, Including Outliers	Total expected amount from Medicare.

Field Descriptions – Medicare Home Health: LUPA

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare Home Health: LUPA accounts.

Field	Description
Claim Error	Error code for the claim level.
Claim Disposition	Disposition code for claim level.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs).
HIPPS Code	Health Insurance Prospective Payment System (HIPPS) code.
Pre SR Total Payment	The total payments expected amount from Medicare before the sequestration reduction is applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Non-timely Submission Reduction	Displays the reduction due to non-timely submission.
Sequestration Reduction (SR)	The 2% sequestration reduction for patients discharged on or after 04/01/2013. The reduction is applied to the expected payment for each line item after any applicable co-payment amounts are applied. This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool. Error Code 267: Total Copay/deductible used from RA to calculate sequestration reduction displays when the actual copay and/or deductible amounts from the Remittance Advice (RA) are used in the calculation instead of estimated values when processing using the Medicare OP reimbursement tool (node).
Total Payment Post SR	The total payments expected amount from Medicare after the sequestration reduction is applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Total Medicare Payment	Total Medicare payment.
Total Patient Responsibility	Patient co-payment, as stipulated by the rules.
Line Item Date of Service (LIDOS)	Dates the service was rendered.
Revenue Code	Revenue code.
HIPPS and CPT Codes	Associated HIPPS and CPT codes.
Billed Units	Number of units billed.
Charges	Total amount billed by the provider.
Expected Base Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data.
Total Payment with Rural Add-on	The total payment expected after the rural add-on is applied.
LUPA Add-on Amount w/Rural Add-on	The LUPA add-on amount combined with the Rural add-on amount.
VBP Amount	Value Based Purchasing amount.
Sequestration Reduction	The 2% sequestration reduction for patients discharged on or after 04/01/2013. The reduction is applied to the expected payment for each line item after any applicable co-payment amounts are applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Total Payment	The total Medicare and patient payments posted to the account, as defined in the data.
Message & Error Codes	Reason for rejection or return, if applicable.
Visit Rate	Displays the number of line items and the expected base payment based on the revenue code.
Adjustments
VC61	Core Based Statistical Area (CBSA) code.
VC85	Code indicating the county where service is rendered.
Quality	Displays Y (Yes) or N (No) if the 2% quality reporting reduction is applied if the facility does not participate.
Labor Percentage	Labor portion percentage.
Non-Labor Percentage	Non-labor portion percentage.
CBSA WI	Core Based Statistical Wage Index.
LUPA Add-on Percentage	Percentage for the Low-Utilization Payment Adjustment (LUPA) add-on.
Rural Add-on Percentage	Percentage for rural add-on.
VBP	Value Based Purchasing factor.
Non-timely Submission	Non-timely submission.

Field Descriptions – Medicare Home Health: PEP, RAP and Continuous Care Reimbusrement

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare Home Health: PEP, RAP and Continuous Care Reimbursement accounts.

Field	Description
Claim Error	Error code for the claim level.
Claim Disposition	Disposition code for claim level.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs).
HIPPS Code	Health Insurance Prospective Payment System (HIPPS) code.
Pre SR Total Payment	The total payments expected amount from Medicare before the sequestration reduction is applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Non-timely Submission Reduction	Displays the reduction due to non-timely submission.
Sequestration Reduction (SR)	The 2% sequestration reduction for patients discharged on or after 04/01/2013. The reduction is applied to the expected payment for each line item after any applicable co-payment amounts are applied. This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool. Error Code 267: Total Copay/deductible used from RA to calculate sequestration reduction displays when the actual copay and/or deductible amounts from the Remittance Advice (RA) are used in the calculation instead of estimated values when processing using the Medicare OP reimbursement tool (node).
Total Payment Post SR	The total payments expected amount from Medicare after the sequestration reduction is applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Total Medicare Payment	Total Medicare payment.
Total Patient Responsibility	Patient co-payment, as stipulated by the rules.
Line Item Date of Service (LIDOS)	Dates the service was rendered.
Revenue Code	Revenue code.
HIPPS Code	Associated HIPPS Code.
Billed Units	Number of units billed.
Charges	Total amount billed by the provider.
Expected Base Payment	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data.
Base Outlier	The base outlier amount.
Total Payment with Rural Add-on	The total payment expected after the rural ass-on is applied.
VBP Amount	Value Based Purchasing amount.
Sequestration Reduction	The 2% sequestration reduction for patients discharged on or after 04/01/2013. The reduction is applied to the expected payment for each line item after any applicable co-payment amounts are applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Total Payment	The total Medicare and patient payments posted to the account, as defined in the data.
Message & Error Codes	Reason for rejection or return, if applicable.
Adjustments
VC 61	Core Based Statistical Area (CBSA) code.
VC 85	Code indicating the county where service is rendered.
Quality	Displays Y (Yes) or N (No) if the 2% quality reporting reduction is applied if the facility does not participate.
Episode Rate	National, standardized 30-day period payment amount.
Labor Percentage	Labor portion percentage.
Non-Labor Percentage	Non-labor portion percentage.
HIPPS Weight	Case-mix weights.
CBSA WI	Core Based Statistical Wage Index.
Outlier Fixed Dollar Loss Ratio	Percentage applied to Episode Rate in the Outlier Calculation.
Rural Add-on Percentage	Percentage for rural add-on.
VBP	Value Based Purchasing factor.
Non-timely Submission	Non-timely submission.