Use the TRICARE Inpatient (ACUTE) Calculator

Use this procedure for the TRICARE Inpatient (ACUTE) Calculator.

Note: The Service From date must be on or after 10/01/2002.

  1. Access the TRICARE Inpatient Calculator (ACUTE) page.
    1. Select Go To > Government Payor Research > TRICARE > Inpatient Calculator. The TRICARE Inpatient Calculator Selection page opens.

      Note: If your facility offers only one type of TRICARE inpatient services, the system bypasses this selection page.

    2. Select Acute from the Type of PPS list and click Next. The TRICARE Inpatient Calculator (ACUTE) page opens.
  2. Specify the calculation criteria and optional values. For more information about each calculation criteria, refer to the Field Descriptions table below.
  3. Click Calculate. The TRICARE Inpatient Calculator Results (ACUTE) page opens. For more information, refer to View the TRICARE Inpatient (ACUTE) Calculator Results.

Note: If using the Recalculate as TRICARE IPPS from the Reimbursement page, the fields automatically populate from the claim. If using the TRICARE Inpatient calculator from the Provider Profile, you must enter the appropriate information (fields do not populate).

The following table describes each of the fields on the TRICARE Inpatient Calculator page.

Field

Description

Bill Type

Bill type

Billed Charges

Amount of charges; required

Discharge Status

Patient’s destination upon discharge (home, LTC, and so on)

Diagnosis Codes

Enter the diagnosis codes for the claim.

Note: If using the Recalculate as TRICARE IPPS from the Reimbursement page, the fields automatically populate from the claim. If using the TRICARE Inpatient calculator from the Provider Profile, you must enter the appropriate information (fields do not populate).

DRG

Diagnosis Related Group code; required

Length of stay

Length of stay, in days

Primary Diagnosis

Enter the primary diagnosis to accommodate the revision of the diagnosis related group (DRG) reimbursement by temporarily reimbursing DRGs at a 20 percent higher rate for COVID-19 patients effective for claims with admissions occurring on or after January 27, 2020.

Procedure Codes

Enter the procedure codes for the claim.

Note: If using the Recalculate as TRICARE IPPS from the Reimbursement page, the fields automatically populate from the claim. If using the TRICARE Inpatient calculator from the Provider Profile, you must enter the appropriate information (fields do not populate).

Service From

First date of service rendered to the patient. This is required information, and defaults to today’s date.

Service Through

Ending date the service was performed. This is required information, and defaults to today’s date. Date cannot be prior to Service From date.

Taxonomy

Enter the correct taxonomy code for the service type to be priced. The taxonomy code field defaults to the General Acute Hospital taxonomy code (282N00000X). For other service types, update this field with the correct taxonomy code.