View the Medicare Inpatient (Rehab) Expected Reimbursement Detail

The information on the Expected Reimbursement Detail page for Medicare Inpatient rehabilitation accounts is different from that of commercial inpatient rehab accounts.

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

Use the following procedure to view the Medicare Inpatient (Rehab) Expected Reimbursement Detail.

  1. Access the Expected Reimbursement Detail page. For more information, refer to View the Expected Reimbursement Details . 
  2. Review the expected reimbursements.
  3. 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 Recalculate as Medicare RFPPS to open the Medicare Calculator and recalculate the total for a Medicare rehabilitation facility.
    • Click an amount in the Payment or Outlier column to get a step-by-step calculation for that amount.
    • Click View in the Calculation Details column. The Calculation Details page opens. For more information, refer to View Expected Reimbursement Calculation Details.

The following table describes each of the fields on the Expected Reimbursement Detail page for Medicare rehab inpatients. The fields are listed in alphabetical order by section.

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

CMG

Case Mix Group code

Covered Charges

Amount of charges covered by Medicare, Workers’ Compensation or TRICARE

Covered Days

Number of covered days

IME

Reimbursement for Indirect Medical Education operating costs

LIP

Low Income Patient amount

Outlier

Total amount of extraordinarily high cost services paid by Medicare

Payment

Total expected Medicare reimbursement, minus the outlier cost

Reimbursement Type

Reimbursement type, either expected reimbursement or RA, if applicable (the latest RA is shown if there are multiple RAs)

Remittance Advice Payment Code Definitions

Definitions of Remittance Advice payment codes listed

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

Weight

Weight factor established by Medicare for each CMG