View the Medicare Hospice Expected Reimbursement Detail
Use the following procedure to view the Expected Reimbursement Detail for a Medicare hospice account.
Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.
The expected reimbursement for hospice Medicare accounts is based on base payment rates that are assigned to the applicable revenue codes. The base rates are updated annually by CMS and are effective 10/1 through 9/30 each year. The Expected Reimbursement Detail screen displays the payment by revenue code. The APC column is not applicable on hospice claims and will always be blank on the screen.
Procedure
- Access the Expected Reimbursement Detail page for a Medicare Hospice 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 Medicare OPPS 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.
Field Descriptions – Medicare Hospice
The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare hospice accounts. The fields are listed in alphabetical order.
|
Field |
Description |
|
APC Codes |
Ambulatory Payment Classification codes |
|
APC Payment, Excluding Outliers |
Total reimbursement by the Ambulatory Payment Classification, a set of payment rates based on groups of outpatient services rather than on individual services |
|
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 |
|
Associated CPT or HCPCS codes and modifiers |
|
|
Message & Error Codes |
Reason for rejection or return, if applicable |
|
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 (Lab, DMEPOS, PEN and therapies) |
|
Line Item Error Definitions |
Error code for the line-item level |
|
No. |
Sequential reference number of the line item |
|
Outlier Amount APC, only |
Total amount for extraordinarily high cost (cost outlier) for that service date |
|
New Tech Pass-Through Payments |
Total reimbursement for certain high-cost items, such as implants, high cost drugs, and biologicals, for which the actual or higher cost is passed through to the payor |
|
Payment Status Code Definitions |
Definitions of Payment Status Codes listed |
|
Reimbursement Type |
Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs) |
|
Revenue code |
|
|
Line Item Date of Service (LIDOS) |
Dates the service was rendered |
|
Payment Status Indicators |
APC payment status 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 APC Payment |
Payment by APC for the line item |
|
Total Payments, Including Outliers |
Total expected amount from Medicare |
|
Outlier Amount APC, only |
APC amount for extraordinarily high cost |