Use this procedure to view the Acute Medicare Inpatient Calculator results.
Procedure
- Access the Inpatient Medicare Calculator (ACUTE) results.
- Select Go To > Government Payor Research > Medicare > Inpatient Calculator. The Medicare Inpatient Calculator Selection page opens.
Note: If your facility offers only one type of Medicare inpatient services, the system bypasses this selection page.
- Select Acute from the Type of PPS list and click Next. The Inpatient Medicare Calculator (ACUTE) page opens.
- Select the appropriate criteria and click Calculate. The Inpatient Medicare Calculator (ACUTE) results page opens. For more information about the calculation criteria, refer to Use the Acute Inpatient Medicare Calculator.
- Select Go To > Government Payor Research > Medicare > Inpatient Calculator. The Medicare Inpatient Calculator Selection page opens.
- View the calculation results.
- To view additional details regarding the information on this page:
- Click the Bill Type link to display the Billing Type Definition page. For more information, refer to Billing Type Definition.
- Click a link in the reimbursement table to display the step-by-step calculation details for a specific value.
Field Descriptions
The following table describes each of the fields on the Medicare Inpatient Calculator (ACUTE) results page.
|
Field |
Description |
|
Capital Payments - DSH |
Reimbursement for Disproportionate Share Hospital capital costs |
|
Capital Payments - IME |
Reimbursement for Indirect Medical Education capital costs |
|
Capital Payments - Outliers |
Reimbursement for Capital (equipment and facility) costs |
|
Capital Payments - Base |
Total Capital adjustment |
|
Covered Charges |
Amount of charges covered by Workers’ Compensation or Medicare |
|
Covered Days |
Number of covered days |
|
DRG |
Diagnosis Related Group code |
|
DRG Payment |
DRG payment, consisting of the DRG weight multiplied by the conversion factor. Includes pass-through amounts |
|
DRG Weight |
DRG weight factor established by Medicare for each DRG |
|
Operating Payments - DSH |
Reimbursement based on Disproportionate Share Hospital operating costs |
|
Operating Payments - IME |
Reimbursement for Indirect Medical Education operating costs |
|
Operating Payments - Outliers |
Reimbursement based on operating (nursing, ancillary and support) costs |
|
Operating Payments - Base |
Total operating payments (includes Readmission Reduction Percentage Adjustment (RRP), Value Based Purchasing Adjustment (VBP) and the Low Volume Adjustment (LVA). |
|
Per Diem Passthrough Amount |
The amount of Medicare Bad debt, Organ acquisition excluding Corneal, and/or Direct graduate medical education. |
|
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 |
|
New Tech & Hemophilia Payments |
New technology and hemophilia payments |