View the Medicare Inpatient (Acute) Expected Reimbursement Detail

The information on the Expected Reimbursement Detail page for Medicare inpatient accounts is different from that of commercial inpatient accounts. This function is applicable if FinThrive reprices inpatient Medicare claims for your facility.

Note: If the Expected Reimbursement Detail is incomplete, click a Service Type link.

Field Descriptions – Medicare Inpatient

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare inpatients. .

Field	Description
Error Code	Reason for rejection or return, if applicable.
100% Medicare Reimbursement with Profile Overrides	The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data (this considers any check boxes applied).
Inpatient Deductible	The deductible amount on the claim. Deductible amounts are determined by the patient Point of Origin (FL15). If FL15 = 4 or D, there is no deductible. Note: If the source is NOT another inpatient facility, the deductible is applied for each benefit period (60 days).
Inpatient Co-Payment	The co-payment amount on the claim. Typically, the amount is determined by the patient’s entire length of stay, including any patient days from a prior admission that is part of the same episode of care (when those days are reflected on the claim). Optionally, this amount can include the patient's current deductible payment from the remittance advice.
Sequestration Reduction	The 2% sequestration reduction on Medicare Inpatient claims for patients discharged on or after 04/01/2013. The reduction is applied to the Total Expected Payment after any applicable co-payment and deductible amounts are applied. Note: This field is shown only if the Apply sequestration reduction option is selected on the reimbursement tool.
Pass Through Payment Amount	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.
Contractual Adjustment	Difference between 100% and actual contract percentage.
Total Reimbursement	100% Medicare – Sequestration + Contractual Adjustment = Final expected for the claim
Payor Reimbursement	The reimbursement amount due to the payor after the deductible, co-payment, and sequestration reductions are applied.
Reimbursement Type	Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)
DRG	Diagnosis Related Group
DRG Weight	DRG weight factor established by Medicare for each DRG
Covered Days	Number of covered days
Covered Charges	Amount of charges covered by Workers’ Compensation or Medicare
Operating Payments	Base – Total operating payments DSH – Reimbursement based on Disproportionate Share Hospital operating costs IME – Reimbursement for Indirect Medical Education operating costs Outliers – Reimbursement based on operating (nursing, ancillary and support) costs
Capital Payments	Base – Total Capital adjustment DSH – Reimbursement for Disproportionate Share Hospital capital costs IME – Reimbursement for Indirect Medical Education capital costs Outliers – Reimbursement for Capital (equipment and facility) costs
New Tech & Hemophilia Payments	New technology and hemophilia payments
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
Operating Adjustments	RRP – Operating adjustment amount for Readmission Reduction Program VBP – Operating adjustment amount for Value Based Purchasing HAC – Operation adjustment amount for Hospital Acquired Conditions
New Tech Adjustment	RRP – New technology adjustment amount for Readmission Reduction Program VBP – New technology adjustment amount for Value Based Purchasing HAC – New technology adjustment amount for Hospital Acquired Conditions
Uncompensated Care Payments	The payment amount withheld that will be redistributed to all providers who receive DSH as an additional Uncompensated Care Payment.
Pass Through Per Diem Amount	The amount of Medicare Bad debt, Organ acquisition excluding Corneal, and/or Direct graduate medical education.
DRG Payment	DRG payment, consisting of the DRG weight multiplied by the conversion factor. Includes pass-through amounts.
Remittance Advice Payment Code Definitions	Definitions of Remittance Advice Payment Codes listed