Use this procedure to view the Medicare Inpatient Calculator results.
Procedure
- Access the Inpatient Medicare Calculator (LTCH) 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 LTCH from the Type of PPS list and click Next. The Inpatient Medicare Calculator (LTCH) page opens.
- Select the appropriate criteria and click Calculate. The Inpatient Medicare Calculator (LTCH) results page opens. For more information about the calculation criteria, refer to Use the LTCH 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. The calculation for the value appears.
Field Descriptions
The following table describes each of the fields on the Medicare Inpatient Calculator (LTCH) page.
|
Field |
Description |
|
Covered Charges |
Amount of charges covered by Workers’ Compensation or Medicare |
|
Covered Days |
Number of covered days |
|
DRG |
Diagnosis Related Group code |
|
DRG Weight |
DRG weight factor established by Medicare for each DRG |
|
Federal Payment |
Dollar amount the federal government will pay for the care |
|
Hospital-Specific Payment |
Hospital-Specific Payment; that portion of the total payment that is “cost-based” rather than “prospectively priced.” Also see Hospital-specific Payment. |
|
Outlier Payment |
Total amount of extraordinarily high cost, in addition to the DRG payment |
|
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 |