Use the SNF PDPM Medicare Inpatient Calculator

1. Access the Medicare Inpatient Calculator (SNF PDPM) page.
   1. 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.

   2. Select PDPM radio button as the type of pricing and click Next. The Medicare Inpatient Calculator (SNF PDPM) page opens.
2. Select the Hospital Identification NPI from the drop down list provided.
3. Enter the following for the Patient Identification section:
   •  Discharge date in the Discharge Date field.
     • This field defaults to the current system date.
     • If you enter a specific discharge date, the results are displayed for the closest date available (from data within the system).
     • You can also click the calendar icon next to the field to select a date from a calendar.
   • The patient's discharge status in the Discharge Status field.
   • The 5-digit HIPPS code reported with the Revenue Code 022 on the claim in the HIPPS Code field.
   • The number of days represented by the HIPPS Code in the HIPPS Days field.
   • If the assessment is late, enter the number of days it is late in the Late Assessment Days field.
4. Make the appropriate selections in the Pricing Options section:
   • Check the Allow HIV Nursing Add-on check box if the diagnosis B20 is billed to apply the 18% adjustment to the nursing component.
   • Check the Apply Quality Reporting check box to apply the 2% quality reporting reduction if the facility does not participate.
   • Check the Apply Sequestration Reduction check box to apply the 2% reduction to the insurance portion of the payment.
   • Check the Apply Value-base Purchasing check box to apply the Value Based Purchasing adjustment to the calculation.
   • The Price as PDPM check box is selected (checked) as the default setting and prices as PDPM. Remove the Price as PDPM check so the calculator prices as RUG-IV on and after 10/01/2019.
   • Enter the change based on the contract terms in the Percent of Medicare field. Traditional Medicare should be 100% and this field defaults to 100%.
5. Click Calculate. The Medicare Inpatient Calculator (SNF PDPM) results page opens. For more information, refer to View the SNF PDPM Medicare Inpatient Calculator Results.

The following table describes each of the fields on the Medicare Inpatient Calculator (SNF PDPM) page.