View the Medicare Inpatient (SNF) Expected Reimbursement Detail

The information on the Expected Reimbursement Detail page for Medicare inpatient Skilled Nursing Facility accounts is different from that of commercial inpatient SNF accounts.

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

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

  1. Access the Expected Reimbursement Detail page for a SNF account. For more information, refer to View the Expected Reimbursement Details .
  2. Review the expected reimbursements
  3. Optionally, you can perform the following actions:

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

Field

Description

Error Code

Reason for rejection or return, if applicable.

 

Total Expected Reimbursement

The calculated reimbursement based on the predefined contract terms and conditions and service type definitions in the system and the repriced claims data

Inpatient Co-Payment

The co-payment amount on the claim. Co-payments for Skilled Nursing Facility (SNF) stays are calculated as follows:

  • Prior days are excluded from the co-payment calculation.
  • The co-payment amount is $148.00 for all days greater than 20.

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.

Payor Reimbursement

The reimbursement amount due to the payor after the deductible, co-payment, and sequestration reductions are applied.

 

Component

Displays the applicable component (PT, OT, SLP, Nursing, NTA, Non-Case Mix, etc.)

Late Assessment (if applicable)

Indicates a late assessment if applicable.

Component Group

Indicates the group (C, H, N, etc.) associated with the component.

Component Rate

Displays the rate amount associated with the component.

Wage Adjusted Rate

Displays the wage adjusted rate amount for the associated component.

Variable Per Diem (VPD) Adjustment Factor (Nursing HIV Add-on, if applicable)

Displays the Variable Per Diem (VPD) adjustment factor for the associated component with the Nursing HIV add on (if applicable).

Variable Per Diem

Displays the Variable Per Diem amount for the associated component (Wage Adjusted Rate multiplied by VPD Adjustment).

 

Variable Per Diem Adjustment Factor by Days

Displays the PT/OT and NT Variable Per Diem Adjustment factors by days (e.g. Days 1-3 (PT/OT 1.00, NT 3.00).

Quality Reporting/Value Based Purchasing Percentages

Displays the percentage used for Quality Reporting and VBP (Value Based Purchasing).

PT + OT Variable Per Diem

Displays the physical therapy plus occupational therapy per diem amount.

NTA Variable Per Diem

Displays the Non-Therapy Ancillary (NTA) per diem amount.

SLP + Nursing + Non Case Mix Variable Per Diem

Displays the per diem amount for Speech-language pathologist (SLP) plus nursing plus non case mix variable.

Subtotal

The subtotal of the three columns to the left: PT + OT Variable Per Diem, NTA Variable Per Diem, and SLP + Nursing + Non Case Mix Variable Per Diem.

No. Days in Range

Displays the number days for each range.

Variable Per Diem Total

Displays the total amount for Variable Per Diem (Subtotal multiplied by the No. Days in Range).