Introducing IRF PRICERActive Reimbursement Components
The Inpatient Rehab Facility Prospective Payment System (IRF PPS) is now the primary reimbursement methodology for inpatient rehabilitation hospital claims paid by Medicare. The primary patient classification mechanism is the CMG (Case Mix Group). Patient information including age, sex, and condition along with detail diagnosis data from the patient record are processed through a complex algorithm to calculate the CMG. Associated with each CMG is a comorbidity indicator with which weighting factors and statistical averages for the length of stay are associated. These data and other hospital-specific and geographic cost factors are the input to the complex IRF PRICER programs used by Medicare fiscal intermediaries to compute Medicare reimbursement for a hospital stay.
IRF PRICERActive Enterprise Components duplicate the calculations used by Medicare for inpatient rehab hospital claim payment. IRF PRICERActive‘ uses the same formulas and Medicare hospital-specific data that the Medicare intermediaries use to calculate claim payments. With IRF PRICERActive‘ you can calculate an estimated Medicare payment for an inpatient rehab facility claim.
IRF PRICERActive Enterprise Components interface directly with all 32-bit or 64-bit .Net or ActiveX capable systems and are available as a component covering 2 fiscal years of Inpatient Rehab reimbursement calculation.
Calculates all components of a Medicare Inpatient Rehab
Federal Payment Amount
Facility Payment Amount
Low-income Payment Amount
Penalty amounts as applicable
Cost Outlier Amount
Also returns the priced CMG, CMG weighting factor, CMG average LOS and CMG description
Compatible with the leading Windows development environments including:
Studio (32-bit or 64-bit)
Microsoft Visual Studio 6.0
IRF PRICERActive components are licensed based upon usage.
For a single site installation, like a health plan, hospital, or university, the IRF PRICERActive components are licensed for internal use based on the size of the installation.
For a Software Developer including a IRF PRICERActive
component in a software package for distribution to an end user, a distribution
agreement is required. Terms: an initial license fee and a per-site fee for each
IRF PRICERActive Component.
Send e-mail to email@example.com or call for more information and pricing.