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
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The 2552-10 format calculates IP Reimbursement across several potential sheets.
PPS Worksheet E, Part A, line 59 TEFRA Worksheet E-3, Part I, line 18 Psych Subprovider Worksheet E-3, Part II, line 31 Rehab Subprovider Worksheet E-3, Part III, line 32 LTCH PPS Worksheet E-3, Part IV, line 22 Critical Access Hospitals (CAHs) Worksheet E-3, Part V, line 30 PPS SNF Services Worksheet E-3, Part VI, line 15 Titles V or XIX Services Worksheet E-3, Part VII, line 40 - Settlement Amount
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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.
PPS Worksheet E, Part A, line 74 TEFRA Worksheet E-3, Part I, line 21 Psych Subprovider Worksheet E-3, Part II, line 34 Rehab Subprovider Worksheet E-3, Part III, line 35 LTCH PPS Worksheet E-3, Part IV, line 25 Critical Access Hospitals (CAHs) Worksheet E-3, Part V, line 33 PPS SNF Services Worksheet E-3, Part VI, line 18 Titles V or XIX Services Worksheet 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).