How To Run the Report
This report is run from Barnestorm Office > Reports > Billing > 15.03 PPS Cost vs Reimb.
o From Dates = Select all episodes whose from date is between the specified dates.
o Thru Dates = Select all episodes whose thru date is between the specified dates.
o Only episodes with at least 1 therapy visit = Selects episodes with only one chargeable therapy visit.
o Update Episode Charges $ Before Printing =
o Last Month = Quickly changes the From and Thru dates to last month.
o Completed episodes only: If From Dates, then the Episode Thru Date must be five days or more before the end date of the report; If Thru Dates, then the EOE claim must have been created.
o Medicare = Selects Medicare PPS episodes (Payer has PPS = Yes and Pay Class = B).
o Non-Medicare = Selects non-Medicare PPS episodes(Payer has PPS = Yes and Pay Class not = B).
o Both = Selects both Medicare and Non-Medicare episodes.
o Program(s) / Team(s)= Filter report by entering program and/or team numbers. Or leave blank to select all.
o Total Cost / Direct Cost = Uses the numbers based on Codes > Rates > Cost per Discipline.
o Select Based on Case Mix Weight = Check this box to enter the range of case mix that you want to pull up on the report.
How to Read the Report
Each episode is marked if it is a LUPA, PEP,SCIC, therapy issue, or Outlier (symbol in front of the chart number). This may help explain right away why the PPS$ is lower or higher than expected. An X means the HIPPS code does not match the supplies, episode was paid with supplies but none are listed on claim. A minus sign shows the patients that are a part of the Decreased episodes. A plus sign shows the patients that are a part of the Increased episodes.
o FromDate = The from date of the episode.
o HIPPS = HIPPS code shown is the code that appears, or may appear, on the EOE claim (after calculated from the patients HIPPS episode).
o PT / OT / ST / SN / MSW / HHA = Each discipline visit count is totaled for the episode.
o Tot = All discipline visits are totaled together.
o $DirCost = The number of each discipline visits multiplied by that disciplines Cost Per Discipline (found in Codes > Rates > cost Per Discipline).
o $SupCost = Are the cost of supplies used for that patient (including the markup).
o PPS$ = The amount to be expected as the final payment. Adjustments are made when the EOE is paid.
o Gain/Loss = Subtracts your $DirCost and $SupCost from your PPS$.This is the Gain/Loss for that episode.
The bottom portion of the report groups the data into different areas.
Decreased means that the HIPPS code compared from RAP to EOE has decreased in PPS$.
Increased means that the HIPPS code compared from RAP to EOE has increased in PPS$. These only include therapy difference,meaning less or more therapy visits were done than expected.