Episodic Revenue Recognition report – Detail fields

Patient Code and Name

Patient's code and full name, stored in Patient>General>Basic.

HIPPS, HHRG, Case Mix, NRS, Weight, M0826/M2200

Assessment related items displayed each on a separate line:

• HIPPS – The Health Insurance Prospective Payment System code. It is the sum of the HHRG and NRS calculations.
• HHRG – The Home Health Resource Group code.
• Case Mix – The Case Mix value for the HHRG.
• NRS – The Non-Routine Supplies (NRS) Severity code. It is generated by the completion of the OASIS RFA-01, 04, or 03 (when used instead of the RFA-04) and is stored in the NRS field on the PPS Information tab in Patient>General>Admissions & Status.
• Weight – The Severity weight for the NRS.
• 0826/M2200 – The number of PPS Therapy visits.

Episode Number

PPS episode number for the reported episode.

EEP, Per Diem Rate and Actual Per Diem Rate

Expected episodic payment value (gross amount from RAP) and per diem value which is calculated as EEP/60.

Service Provided

Type and number of the services provided for the patients by the corresponding disciplines.

Admission and Discharge Date

Patient's current admission and discharge dates, stored in Patient>General>Admissions & Status.

Primary Diagnosis

Patient's primary diagnosis code.

Next Certification

Date of the patient's next certification.

Current Episode Start/End

 Start and end dates of the current episode.

Days and Amount Earned in Report Period

Number of days and amount earned based on the report begin and end dates, and the episode start and end dates. For example, if a patient's episode begins on 2.10.10 and ends on 4.10.10 and the reporting period is the month of February, 2010, the number of earned days is 20. This amount is calculated by taking 2.10.10 (start date of the episode) – 2.29.10 (end date of the report).

First and Last Billable Visits

First and last verified billable services in the episode.

Days and Amount Earned to Date

Number of episode days and the amount earned during the episode.

• If the report end date is equal to or greater than the episode end date, then days from the episode start date to the episode end date plus one day are reported.
• If the report end date is less than the episode end date, then days from the episode start date to the report end date plus one day are reported.

Days and Amount not Earned to Date

Number of days and amount left calculated as 60 minus Days Earned to Date within the reporting period.

 Extra Days and Extra Amount

Number of days and the amount extra earned in the episode.

Extra days are calculated as the episode start date plus 59 days minus the episode end date.

Extra amount is calculated as extra days number multiplied by the EEP rate.

Adjustments Code and Amount

Adjustment type code and adjustment amount as calculated for the Final Claim and the pre- refinement logic, as well as adding the LUPA Add-On amount.

Discipline

Name of the discipline providing services during the reporting period. The top section includes the following disciplines:

• Skilled Nursing
• Physical Therapy
• Occupational Therapy
• Speech Pathology
• Medical Social Services
• Home Health Aide

The bottom section shows supplies that are attached to the services, virtual supplies, and DME as the separate categories.

Visits

Total number of visits for the corresponding discipline within the reporting period.

 Usual and Customary ($)

Total Usual and Customary amount per discipline.

This amount matches the Usual and Customary ($) amount reported on the Drill-Down page.

 Earned Revenue for Period ($)

Total Earned Revenue amount for the period summarized for all disciplines. This amount is calculated as the Per Diem (1/60) amount of the EEP multiplied by the number of days for the episode within the reporting period.

This amount matches the Days and amount Earned in report period entry in the top section of this page.

Contractual Allowance ($)

Total Contractual Allowance amount summarized for all disciplines. It is calculated as

Earned Revenue for Period minus Total Usual and Customary ($) (for all disciplines).

Imputed Outlier Units

Total number of units, in 15 minute increments, used for outlier calculation, of all the services per discipline within the reporting period. The Outlier Calculation unit sorting and unit capping (maximum of 32 units per day) affects this column.

Imputed Outlier Cost

Total outlier cost (calculated using imputed outlier units and outlier unit rates defined in (Administration>Configuration>PPS>Post-Refinement PPS Parameters) of all the services per discipline within the reporting period.

Total

Totals for all disciplines calculated for the Visits and Usual and Customary ($) columns.

Grand Total

Grand total for all disciplines calculated for the Usual and Customary ($), Earned Revenue for Period ($), and Contractual Allowance ($) columns.