View the California Workers’ Compensation (Inpatient) Expected Reimbursement Detail
Use the following procedure to view the California Workers’ Compensation (Inpatient) Expected Reimbursement Detail.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
Procedure
- Access the Expected Reimbursement Detail page for a Worker’s Compensation Inpatient account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
- Optionally, you can perform the following actions:
- Click Reimbursement to display the View Contract Profile page. For more information, refer to View a Contract Profile.
- Click All IP to display the service types on the View Contract Profile page. For more information, refer to View a Contract Profile.
- Click an amount in Implant Amount or Organ Acquisition to place an override on that claim. For more information, refer to Add Account Override Data.
- Click View in the Calculation Details column. The Calculation Details page opens. For more information, refer to View Expected Reimbursement Calculation Details.
Field Descriptions – CA Workers’ Compensation Inpatient
The following table describes each of the fields on the Expected Reimbursement Detail page for California Workers’ Compensation inpatient claims. The fields are listed in alphabetical order.
|
Field |
Description |
|
Capital DSH |
Reimbursement for Disproportionate Share Hospital capital costs |
|
Capital IME |
Reimbursement for Indirect Medical Education capital costs |
|
Capital Outlier |
Reimbursement for capital (equipment and facility) costs |
|
Capital Payment |
Total capital adjustment |
|
Covered Charges |
Amount of charges covered by Medicare, Workers’ Compensation or TRICARE |
|
Covered Days |
Number of covered days |
|
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 Payment |
Payment consisting of the DRG weight multiplied by the conversion factor. Includes pass-through amounts |
|
DRG Weight |
DRG weight factor established by Medicare for each DRG |
|
Error Code |
Reason for rejection or return, if applicable |
|
Implant Amount |
Percentage of charges (selected by the facility) used to estimate the implant payment |
|
Operating DSH |
Reimbursement based on Disproportionate Share Hospital operating costs |
|
Operating IME |
Reimbursement for Indirect Medical Education operating costs |
|
Operating Outlier |
Reimbursement based on operating (nursing, ancillary and support) costs |
|
Organ Acquisition |
Extra charges for the cost of obtaining organs for transplant (if any) |
|
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 |
|
Total Pass-Through |
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 |