View the Florida Medicaid Inpatient Expected Reimbursement Detail
Use the following procedure to view the Florida Medicaid 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 Florida Medicaid Inpatient account. For more information, refer to View the Expected Reimbursement Details .
- Review the expected reimbursements.
Note: If the covered days exceeds 45, the Covered Days column displays 45, and the message “Inpatient cap applied” appears below the details.
- 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 the Service Type name to display the service types on the View Contract Profile page. For more information, refer to View a Contract Profile.
- Click View in the Calculation Details column. The Calculation Details page opens. For more information, refer to View Expected Reimbursement Calculation Details.
- Click Re-calculate as Medicare IPPS to display the Medicare Outpatient Calculator. For more information, refer to Use the Medicare Outpatient Calculator.
- Click Re-calculate as TRICARE IPPS to display the TRICARE Outpatient Calculator. For more information, refer to Use the TRICARE Non-OPPS Calculator.
Field Descriptions – Florida Medicaid Inpatient Accounts
The following table describes the fields on the Expected Reimbursement Detail page for Florida Medicare Inpatient claims.
|
Field |
Description |
|
Covered Days |
Number of covered days |
|
Effective Date |
Effective date of the current contract rates |
|
Error Code |
Reason for rejection or return, if applicable |
|
Inpatient Per Diem |
Florida Medicaid pays a per diem (daily rate) for inpatient hospital care and treatment. The per diem covers all services and items furnished during a 24-hour period. |
|
NHS Program Payment |
Medicaid reimburses the initial newborn hearing screening procedure as a supplement to the usual per diem |
|
Total Charges |
The amount of total charges |
|
NPI |
Facility’s ten-digit National Provider Identification (NPI) number required on all claims |
|
Per Diem Payment |
Per diem payment |
|
Reimbursement Type |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs) |
|
Skilled Nursing Unit Per Diem |
Florida Medicaid pays a per diem (daily rate) for hospital-based skilled nursing services. The per diem covers all services and items furnished during a 24-hour period. |
|
State ID |
Two-letter state identifier used by Medicare (e.g., FL) |
|
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 |