Use this procedure to view the Rehab Medicare Inpatient Calculator results.
Procedure
- Access the Inpatient Medicare Calculator (REHAB) results.
- Select Go To > Government Payor Research > Medicare > Inpatient Calculator. The Medicare Inpatient Calculator Selection page opens.
Note: If your facility offers only one type of Medicare inpatient services, the system bypasses this selection page.
- Select Rehab from the Type of PPS list and click Next. The Inpatient Medicare Calculator (REHAB) page opens.
- Select the appropriate criteria and click Calculate. The Inpatient Medicare Calculator (REHAB) results page opens. For more information about the calculation criteria, refer to Use the Rehab Inpatient Medicare Calculator.
- Select Go To > Government Payor Research > Medicare > Inpatient Calculator. The Medicare Inpatient Calculator Selection page opens.
- View the calculation results.
- Click a link in the reimbursement table to display the step-by-step calculation details for a specific value. The calculation for the value appears.
Field Descriptions - Medicare Inpatient Calculator (REHAB)
The following table describes each of the fields on the Medicare Inpatient Calculator (REHAB) results page.
|
Field |
Description |
|
CMG |
Case Mix Group code |
|
Covered Charges |
Amount of charges covered by Workers’ Compensation or Medicare
|
|
Covered Days |
Number of covered days
|
|
Error Code |
Reason for rejection or return, if applicable, for the line item |
|
IME |
Reimbursement for Indirect Medical Education operating costs |
|
LIP |
Low Income Patient amount
|
|
Non-Covered Charges |
The amount of non-covered charges (not disallowed charges)
|
|
Outlier |
Total amount of extraordinarily high cost services paid by Medicare
|
|
Payment |
Total expected Medicare reimbursement, minus the outlier cost
|
|
Reimbursement |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs) |
|
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 |
The factor that is multiplied by the base rate to calculate the payment; each CMG has a unique weight |
Field Descriptions - Medicare Inpatient Calculator for Per Diem
The following table describes each of the fields on the Medicare Inpatient Calculator for any per diem calculation.
|
Field |
Description |
|
Covered Days |
Number of covered days
|
|
Per Diem |
Amount reimbursed per day |
|
Reimbursement |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs) |
|
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
|