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IPPS Dashboard Definitions

PPS Profile - Cost Report Based

The key measurements in this section are based on a hospital's annual cost report. The cost report contains information such as facility characteristics, utilization data, cost and charges by cost center (in total and for Medicare), Medicare settlement data, and financial statement data. CMS maintains the cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS) which is updated quarterly and is based on a hospital's fiscal year.

Total IPPS Payment

The 2552-10 format calculates IP Reimbursement across several potential sheets.

PPSWorksheet E, Part A, line 59
TEFRAWorksheet E-3, Part I, line 18
Psych SubproviderWorksheet E-3, Part II, line 31
Rehab SubproviderWorksheet E-3, Part III, line 32
LTCH PPSWorksheet E-3, Part IV, line 22
Critical Access Hospitals (CAHs)Worksheet E-3, Part V, line 30
PPS SNF ServicesWorksheet E-3, Part VI, line 15
Titles V or XIX ServicesWorksheet E-3, Part VII, line 40

Settlement Amount

The NPR Settlement Amount is the Balance due provider/(Program). It is the difference between the Total IP Reimbursement (above) and the total interim payments for the cost reporting period less any tentative settlements previously made by the MAC.

PPSWorksheet E, Part A, line 74
TEFRAWorksheet E-3, Part I, line 21
Psych SubproviderWorksheet E-3, Part II, line 34
Rehab SubproviderWorksheet E-3, Part III, line 35
LTCH PPSWorksheet E-3, Part IV, line 25
Critical Access Hospitals (CAHs)Worksheet E-3, Part V, line 33
PPS SNF ServicesWorksheet E-3, Part VI, line 18
Titles V or XIX ServicesWorksheet E-3, Part VII, line 18

Settlement Amount as % of Total Payment

A Settlement Amount percentage is calculated as the Settlement Amount (above) divided by Total IPPS Payment (above).

Outlier Amount

Medicare makes additional payments to hospitals for patients with costs that are extraordinarily high due to severity of illness and/or complicating conditions. The amount of outlier payments is from Worksheet E, Part A, line 2.

Outlier as % of Total

An Outlier percentage is calculated as the Outlier Amount (above) divided by Total IPPS Payment (above).