Medicare

The Medicare repricing option of Contract Manager automatically reports the expected reimbursement on Medicare claims—Inpatient Acute, Outpatient, Skilled Nursing Facility (SNF), Long Term Care (LTC), Psych, and Rehab. This tool identifies both underpayments and overpayments, creates work lists to determine the potential gain from rebilling, and produces reports that most facilities must currently produce manually.

Using Medicare calculators to monitor the impact of code assignments, you can forecast the impact of scheduled changes and estimate patient co-payments in your outpatient centers.

Hospital-specific Payment

For Long Term Care Hospital (LTCH) and Psych PPS, payment is based on a blend of the hospital-specific payment and the Federal payment. The hospital-specific payment is a percentage of the payment the hospital would have received BEFORE the new Prospective Payment System (PPS) was initiated.

By blending the old payment and the new over several years, the government eases the pain of transition from the old cost reimbursed systems to the new prospective payment systems.

Currently, LTCH is 80% Federal and 20% Hospital-specific. So, if the old payment would have been $50,000 and the new would be $40,000, the payment would be 20% of $50,000 ($10,000) PLUS 80% of $40,000 ($32,000), for a total payment of $42,000. Then, next year - when hospital-specific percent = 0, the payment would be 100% of the Federal ($40,000).

How To Topics

Refer to the menu on the left for instructions on managing provider profiles, using calculators, and utilizing reimbursement tools (nodes).

The following topics provide step-by-step instructions for managing provider profiles, using calculators, and utilizing reimbursement tools (nodes).

• Manage the Medicare Provider Profile
• Work with Medicare Inpatient Calculators
• Work with the Medicare Outpatient Calculator
• Medicare: Reimbursement Tool
• View Accounts with Remittance Advice Variance