View the SNF PDPM Medicare Inpatient Calculator Results

Use this procedure to view the SNF PDPM Inpatient Medicare Calculator results.

Field Descriptions

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

Field	Description
Selection Criteria
NPI	Facility’s ten-digit National Provider Identification (NPI) number required on all claims.
Discharge Date	Patient’s date of discharge.
Discharge Status	Patient’s discharge status.
HIPPS Code	5-digit HIPPS code reported with Revenue Code 022 on the claim.
HIPPS Days	Number of days represented by the HIPPS Code.
Late Assessment Days	If the assessment is late, enter the number of days it is late in this field.
Pricing Options
Allow HIV Nursing Add-on	Displays Y (Yes) or N (No) if this diagnosis B20 is billed to apply the 18% adjustment to the nursing component.
Apply Quality Reporting	Displays Y (Yes) or N (No) if the 2% quality reporting reduction is applied if the facility does not participate.
Apply Sequestration Reduction	Displays Y (Yes) or N (No) if the 2% reduction is applied to the insurance portion of the payment.
Apply Value-base Purchasing	Displays Y (Yes) or N (No) if the Value Based Purchasing adjustment is applied to the calculation.
Price as PDPM	Displays Y (Yes) or N (No) if priced as PDPM. If No, the calculator priced as RUG-IV.
Percent of Medicare	Displays Y (Yes) or N (No) if based on the contract terms.
SNF Reimbursement for PDPM
Error Code	Reason for rejection or return, if applicable.
Gross 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 Deductible	The deductible amount on the claim.
Inpatient Co-Payment	The co-payment amount on the claim.
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.
Override Amount	The override amount on the claim.
Quality Reporting/Value Based Purchasing Percentages	If applicable, the Quality Reporting and/or Value Based Purchasing Percentage displays in this column.
RUG-IV	If applicable, displays the RUG-IV code.
Covered Days	If applicable, displays the RUG-IV number of days covered.
RUG-IV Rate	If applicable, displays the RUG-IV rate based on the RUG-IV code.
Payor Reimbursement	The reimbursement amount due to the payor after the deductible, co-payment, and sequestration reductions are applied.
Component	Lists the various service components in a SNF stay.
Late Assessment (if applicable) -	When applicable HIPPS code "ZZZZZ" is billed with the applicable number of days. This default code maps to HIPPS components PPAY, which represents the lowest payment rates for each category.
Component Group	The HIPPS code assigned to each component (i.e., PT, OT, SLP, etc.)
Component Rate	Base Rate (not wage adjusted) for the HIPPS code assigned to the component group.
Variable Per Diem (VPD) Adjustment Factor PT/OT	The adjustment factor assigned to PT & OT services.
Variable Per Diem (VPD) Adjustment Factor NT	The adjustment factor assigned to NT services.
VPD Wage - Adjusted Rate PT/OT	PT/OT rate with wage and per diem adjustments applied.
VPD Wage - Adjusted Rate NT	NT rate with wage and per diem adjustments applied.
Nursing with HIV add-on (if applicable)	When diagnosis code B20 is present, the nursing component receives a 1.18% adjustment.
SLP, Nursing & Non Case Mix Wage - Adjusted Amount - No Variable Per Diem	This is the wage adjusted amount on the Nursing and Non-Case mix components.
Calculation	The final adjusted amount per component.
Subtotal	Includes the variable per diem adjusted totals for each day range.
No. Days in Range	The number of days assigned to each day range.
Variable Per Diem	The total expected payment for each day range.