View the Medicare Psych PPS Expected Reimbursement Detail

The information on the Medicare Psych PPS Expected Reimbursement Detail page pertains to Medicare IPF PPS (Inpatient Psychiatric Facility Prospective Payment System) accounts.

Use the following procedure to view the Medicare Psych PPS Expected Reimbursement Detail.

Field Descriptions – Medicare Psych PPS

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare Psych - PPS claims. The fields are listed in alphabetical order.

Field	Description
Error Code	Reason for rejection or return, if applicable.
Inpatient Co-Payment	The co-payment amount on the claim. 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).
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. If the source is NOT another inpatient facility, the deductible is applied for each benefit period (60 days).
Payor Reimbursement	The reimbursement amount due to the payor after the deductible, co-payment, and sequestration reductions are applied.
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.
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
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.
Federal Payment	The portion of government payment under the “new,” perspective payment system. This is paid in conjunction with the Hospital Payment. For more information, refer to Hospital-specific Payment.
Hospital Payment	The portion of government payment under the “old,” cost-based payment system. This is paid in conjunction with the Federal Payment. This will be phased out in several years. For more information, refer to Hospital-specific Payment.
Outlier	Total amount of extraordinarily high cost services paid by Medicare
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
Comorbidity Groups	Concurrent but unrelated pathological or disease processes.
Diagnosis Code	ICD-10 Diagnosis Code
Diagnosis Code Sequence	The sequence that the codes are listed on the UB92. The first code is labeled Principle.
Number of ECT Procedures	The number of ECT procedures
ECT Payment	Displays the Psych ECT (electro convulsive therapy) Rate payment amount.
Patient Age	The calculation of the Service To date minus the Patient’s Date of Birth.