Place
the number of days paid at each of the rates listed above in the
second column of the work sheet.
6.2.1 If
there is more than one rate with an individual third-party payer
during the base period, the RTC shall provide the total number of
patient days paid by the payer at each rate. Total patient days will
be used in determining the most favored rate for the facility. The
following is an example of multiple rates paid by an individual
payer during the RTC’s base period:
Example: RTC F has negotiated three
separate rates with a third-party payer over its base period. The
three rates were reported as follows:
1. $295/day from July 2013,
through October 31, 2013 - 2,000 patient days;
2. $315/day from November 1,
2013, through February 29, 2014 - 3,000 patient days;
3. $330/day from March 1, 2014,
through June 30, 2014 - 2,000 patient days.
6.2.4 The following examples represent
the methodology used in calculating the TRICARE base year facility
rate from data provided under Item #9 of the DHA Form 771:
Example: RTC G provided the following
third-party reimbursement data under Item #9 of the DHA Form 771
as part of the certification process:
Item #9 Of DHA Form 771 (Modified
For Example)
Third-Party Payers
|
Rate Accepted
|
Patient Days
|
*** - State or local
Government agency.
|
AA
|
$253
|
312
|
BB
|
527
|
207
|
CC
|
402
|
163
|
DD ***
|
212
|
198
|
EE
|
454
|
371
|
FF
|
603
|
118
|
GG
|
317
|
446
|
HH
|
489
|
538
|
II
|
552
|
319
|
JJ
|
503
|
132
|
Step 1: Array
the rates in descending order from lowest to highest with corresponding
patient days paid at each rate:
(1)
Rates
|
(2)
Patient
Days
|
(3)
Cumulative
Patient Days
|
(4)
Percent Cumulative Patient
Days
|
$212
|
|
198
|
|
198
|
|
7.1
|
%
|
253
|
|
312
|
|
510
|
|
18.2
|
|
317
|
|
446
|
|
956
|
|
34.1
|
|
402
|
|
163
|
|
1,119
|
|
39.9
|
|
454
|
|
371
|
|
1,490
|
|
53.1
|
|
489
|
|
538
|
|
2,028
|
|
72.3
|
|
503
|
|
132
|
|
2,160
|
|
77.0
|
|
527
|
|
207
|
|
2,367
|
|
84.4
|
|
552
|
|
319
|
|
2,686
|
|
95.8
|
|
603
|
|
118
|
|
2,804
|
|
100.0
|
|
|
Total
|
2,804 Patient Days
|
Step 2: Sum the
patient days in column 2, which in this particular example equals
2,804 patient days.
Step 3: Calculate
33-1/3% of the total patient days by multiplying total patient days
figured in Step 2 by 0.3333.
(2,804 patient days x 0.3333
= 934.57 patient days)
Step 4: Go down in the cumulative patient
day column (column 3) to where 33-1/3% of the patient days lie (934.57).
Step 5: Go
across to the rate in column 1 in which 33-1/3 of the cumulative
patient days fall. This represents the base year/period facility
rate. The base year/period rate in this example would be $317 (refer
to table above).
Example: RTC H
provided the following third-party reimbursement data under Item
#9 of the DHA Form 771 as part of the certification process:
Item #9 Of DHA Form 771 (Modified
For Example)
Third-Party Payers
|
Rate Accepted
|
Patient Days
|
*** - State or local
Government agency.
|
AA
|
$425
|
|
201
|
|
BB ***
|
288
|
|
600
|
|
CC ***
|
235
|
|
63
|
|
DD ***
|
215
|
|
1,040
|
|
EE
|
365
|
|
276
|
|
FF
|
515
|
|
168
|
|
GG ***
|
288
|
|
346
|
|
HH
|
489
|
|
538
|
|
II
|
425
|
|
319
|
|
JJ
|
450
|
|
132
|
|
Step 1: Array
the rates in descending order from lowest to highest with corresponding
patient days paid at each rate:
(1)
Rates
|
(2)
Patient
Days
|
(3)
Cumulative
Patient Days
|
(4)
Percent Cumulative Patient
Days
|
$215
|
|
1,040
|
|
1,040
|
|
28.2
|
%
|
235
|
|
63
|
|
1,103
|
|
29.9
|
|
288
|
|
946
|
|
2,049
|
|
55.6
|
|
365
|
|
276
|
|
2,325
|
|
63.1
|
|
425
|
|
520
|
|
2,845
|
|
77.2
|
|
450
|
|
132
|
|
2,977
|
|
80.8
|
|
489
|
|
538
|
|
3,515
|
|
95.4
|
|
515
|
|
168
|
|
3,683
|
|
100.0
|
|
|
Total
|
3,683 Patient Days
|
Step 2: Sum
the patient days in column 2, which in this particular example equals 3,683 patient
days.
Step 3: Calculate 33-1/3% of the total
patient days by multiplying total patient days figured in Step 2
by 0.3333.
(3,683
patient days x 0.3333 = 1,227.54 patient days)
Step 4: Go down in the cumulative patient
day column (column 3) to where 33-1/3% of the patient days lie (1,227.54).
Step 5: Go across to the rate in column
1 in which 33-1/3 of the cumulative patient days fall. This represents
the base year/period facility rate. The base year/period rate in
this example would be $288 (refer to table above).