IRF PRICERActive Medicare Reimbursement Components

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IRF PRICERActive™ Reimbursement DLL

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 administrative contractors to compute Medicare reimbursement for a hospital stay.

IRF PRICERActive™ Reimbursement DLL duplicates 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 contractors use to calculate claim payments. With IRF PRICERActive‘ you can calculate an estimated Medicare payment for an inpatient rehab facility claim.


IRF PRICERActive™ Reimbursement DLL interfaces directly with .Net capable systems and are available as a component covering 2 fiscal years of Inpatient Rehab reimbursement calculation. This product utilizes Microsoft SQL Server components for high-performance in large-scale enterprise and web-based applications.

Features include:

  • Calculates all components of a Medicare Inpatient Rehab PPS payment:
    • 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:

  • Microsoft Visual Studio
  • Microsoft .Net Core (.Net, 6, 7, 8)
  • Microsoft .Net Framework 4.6.2+
  • Microsoft SQL Server


IRF PRICERActive™ Reimbursement DLL is licensed based upon usage.

For a single site installation, like a health plan, hospital, or university, the IRF PRICERActive™ component is licensed for internal use based on the size of the installation.

For a Software Developer including the IRF PRICERActive™ Reimbursement DLL 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  IRF PRICERActive™.

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