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  • e CCH Reimbursement ToolKit provides seven separate

calculators. e calculators, accessed via the Internet, link directly to related laws, regulations, and final rules, so you can examine the rationale behind the calculations. In addition, reports of each calculation are generated with the ability to save, print, or e-mail. And, each calculator features a wider geographic location drop-down pick list to accommodate longer names. eToolKit also provides information from 2004 through 2008.

Calculators Inpatient Prospective Payment System:

  • e hospital-specific DRG payment rate for the benefi-

ciary’s case. Whether the case qualifies for an outlier payment, and, if it qualifies, what the outlier payment will be.

  • e ability to simply enter a Provider Number for faster

and easier calculations. Wage Index Data, which now includes blended wage values for superior accuracy.

Outpatient Prospective Payment System (enhanced to calculate up to 100 codes at one time):

  • e hospital-specific payment amount for each HCPCS

and APC classification assigned to the beneficiary’s case. Whether the case qualifies for an outlier payment, and, if it qualifies, what the outlier payment will be.

  • e ability to simply enter a Provider Number for faster

and easier calculations. Wage Index Data, which now includes blended wage values for superior accuracy.

Long-term Care Hospital Prospective Payment System:

  • e LTCH specific LTC-DRG payment rate for the ben-

eficiary’s case. Whether the case qualifies for a high-cost outlier and/or short-stay outlier payment, and, if it qualifies, what the outlier payment will be.

Inpatient Rehabilitation Facility Prospective Payment System:

  • e IRF specific payment rate for each case.

If the case qualifies for transfer per diem payment. Whether the case qualifies for an outlier payment, and, if it qualifies, what the outlier payment will be.

Physician Fee Schedule Enhanced to calculate up to 100 codes at one time:

  • e Medicare payment amount under the Physician Fee

Schedule (80% of the lesser of the doctor’s actual charge or fee schedule amount). A service’s eligibility for the Health Professional Shortage Area Bonus.

For each calendar year, a service’s eligibility for the Physician Scarcity Area Bonus.

Skilled Nursing Facility Prospective Payment System Calculator:

  • e SNF’s specific RUG payment rate for each benefi-

ciary’s case. Whether the case qualifies for an adjustment under either the Balanced Budget Refinement Act of 1999 (BBRA) or the Benefits Improvement and Protection Act of 2000 (BIPA). Inpatient Psychiatric Facility Prospective Payment System: Hospital-specific DRG payment rate for each case. Whether the case qualifies for an outlier payment, and, if it qualifies, what the outlier payment will be.

Where applicable, the calculators will also determine whether or not a case qualifies for outlier payment and determine that outlier payment rate. You can print, save, or e-mail reports generated by the calculators. In addition, laws, regulations, and final rules on which the calculations are based are linked from the CCH Medicare and Medicaid Guide to the calculators.

Specifications Internet: Updates as needed.

Related CCH Products

Among the CCH loose-leaf Reporters and other publica- tions are several that contain helpful information for dealing with problems faced by hospitals, nursing homes, and oth- ers with a stake in Medicare-Medicaid programs, including their accounting and other advisers. Below is a list of some of these Reporters and publications.

Physicians’ Guide to Medicare

  • e Physicians’ Medicare Guide is an easy-to-read, easy-

to-use summary of Medicare rules applicable to physicians and their billing departments. is one-volume Reporter contains Medicare coverage rules, physician payment rules (including the full Physician Fee Schedule), potential Medi- care penalties, QIOs, payment rules for laboratories and suppliers, claims filing, and appeals procedures.

Social Security taxes and benefits

Social Security taxes and benefits under federal laws are in CCH’s Unemployment Insurance Reporter. Unemployment benefits and taxes under federal law and state unemploy- ment compensation systems are also fully covered.

©2007 CCH. ALL RIGHTS RESERVED.

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