View the LTCH Medicare Inpatient Calculator Results

Use this procedure to view the Medicare Inpatient Calculator results.

  1. Access the Inpatient Medicare Calculator (LTCH) results.
    1. 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.

    2. Select LTCH from the Type of PPS list and click Next. The Inpatient Medicare Calculator (LTCH) page opens.
    3. Select the appropriate criteria and click Calculate. The Inpatient Medicare Calculator (LTCH) results page opens. For more information about the calculation criteria, refer to Use the LTCH Inpatient Medicare Calculator.
  2. View the calculation results.
  3. To view additional details regarding the information on this page:
    • Click the Bill Type link to display the Billing Type Definition page. For more information, refer to Billing Type Definition.
    • 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.

The following table describes each of the fields on the Medicare Inpatient Calculator (LTCH) page. For internal users only, the source information is given for some fields, in the format: “Table.Field.” The URL for this page is mcr_ltch_calculator_output.asp.

Field

Description

Covered Charges

Amount of charges covered by Workers’ Compensation or Medicare

Source: Billipra.COV_CHGS

Covered Days

Number of covered days

Source: UB-92, FL07; UB-04 FL39/Code 70

Billmast.COVDAYS

DRG

Diagnosis Related Group code

Source: Billmast.DRG

DRG Weight

DRG weight factor established by Medicare for each DRG

Federal Payment

Dollar amount the federal government will pay for the care

Hospital-Specific Payment

Hospital-Specific Payment; that portion of the total payment that is “cost-based” rather than “prospectively priced.” Also see Hospital-specific Payment.

Outlier Payment

Total amount of extraordinarily high cost, in addition to the DRG payment

Source: Billmast.MCROUTLIER

Reimbursement Type

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

Total Reimbursement

The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data

Source: Billmast.EXPPAY