The Medicare Reimbursement Amount Report is designed to help your organization more effectively review average Medicare Reimbursements and compare your reimbursements to that of other agencies. The solution includes two new tables. The first table includes annual figures for the most recent year represented in the latest data release, the prior year and rolling 12 month totals. This table includes a link that opens a second table which itemizes the reimbursement amounts by month for the chosen hospice.
Understanding the Metrics
Stays vs. Episodes
We provide the option to display the metrics in this table calculated on episodes or stays.
- There are two radio buttons above the table on the right. Selecting one or the other will update the table to include data based on your selection.
- The meaning and presentation of the metrics in both tables is identical - the only difference being whether the metrics was calculated based on stays or episodes.
- An example image of each is included below.
To simplify in this article, rather than defining each metric twice, we will use stays/episodes to identify that the metric is defined the same for both.
Start Date vs. End Date
We also provide the option to choose whether the metrics are calculated based on the start date of a stay or episode or on the end date of the stay or episode. Make this selection by choosing the radio button for start date or end date at the top right of the table. The metrics in the table will update to reflect stays or episodes that have either start dates or end dates that fall within the reporting period specified at the top of each section of the table.
There are two metrics included for each home health agency listed in this table:
- Total Reimbursement - This is the total amount, in dollars, that the hospice in each row received for hospice services during the period identified in the top header.
- Average $ per Stay/Episode - This metric is the Total Reimbursement divided by the total number of stays/episodes started during the same reporting period. (see note.)
Since we count stays/episodes based on the start date, the most recent averages will be smaller than actual because some because some stays/episodes will have started (and been counted) but we don't have reimbursement amounts for all claims in the stay because the stay is still incomplete. That is, the stay/episode continues on beyond the end of the reporting quarter and that reimbursement can't be added to the total.
Medicare Reimbursement Amount
The top table contains a listing of all home health agencies in the chosen Market (State). Each table has the following 4 sections:
- Home Health Identification Information - This identifies the agency represented in each row, by Name, NPI, and County/ZIP code. This section includes the "Show Details" link that opens the detail table for the hospice in the row.
The Category Column includes the row headers for the metrics in each row for all succeeding columns.
- Most recent reported quarter Year To Date - This section includes the data for the calendar year of the most recent data release. The metrics equal the sum of all home health reimbursements for the agency in each row in the top number. The bottom number is the average reimbursement per stay/episode for the same group of patients in the same period. The State and National averages for the per stay/episode metric are included in the next columns for comparison.
- Previous Calendar Year - This section includes the same metrics for the home health agency in each row calculated from the entire previous calendar year of data. Again, the State and National metrics are included as a baseline for comparison.
- 12 month Rolling - this metric shows the same metrics for the home health agency in each row using data from a rolling 12 month period. Since our data is updated quarterly, this will always be a period of four rolling quarters including the most recent reported quarter and the three previous quarters.
For one quarter of data each year, when our latest data set aligns with the last quarter in the year, the most recent year to date numbers and the 12 month rolling will be identical.
- Example 1: When our latest data release is for the last quarter in the year, Q4, the most recent section Year to date would include quarters 1, 2, 3, and 4 for that year. The 12 month rolling would include the most recent quarter and the previous 3 quarters for that same year. Hence, they are the same.
- Example 2: In the next quarter, which would be Q1, the Year to Date section would only include one quarter, whereas the 12 month rolling would still include a full year worth of reimbursements.
Why does the metric "Average $ per stay/episode" show "ins?" When there are fewer than 11 patients represented in the claims that produce the total revenue, we can't divide the revenue by the number of patients because the average $ per stay/episode metric could be used to divide the Total Revenue metric and identify a patient count <11. For more information, see Data and Metrics - <11, ins, and hyphen "-".
Reimbursement Detail Table
When you click on "Show Details" under the NPI for any listed home health agency, the reimbursement detail table will open up below the top table.
Only the image for the Agency Reimbursement Detail for episodes will be shown here. The only difference you would see is the word "stay" wherever "Billing Episode" appears in the second column.
There are three metrics that appear for each month. These allow you to compare the monthly metrics in detail, to identify trends, or to compare specific months.
- Total Reimbursement - This is the total amount, in dollars, that the chosen home health agency received for home health services for stays/episode started during the month in each column for the year in each row.
- Stay/Episode Count - this is the number of home health stays/episodes started during the month in each column for the year in each row.
- $ per Stay/Episode - This metric is the Total reimbursement divided by the number of stays/episodes.
Final four columns
In order to allow some year over year comparisons, we have included some averages that align to the most recent reported data.
- CY Avg - (Calendar Year) - These metrics reflect averages for all available months for the year in the row. In the example above, 2018 only has three months of data, so the YTD is the average for those three months. For 2017, since all months have data, this is the average for 12 months.
- YTD Avg - (Year to Date) - In the year from the most recent quarter of data, this is the average for all months represented. In previous years, this is the average for the same months that are recorded for the year in the top row. In the example above, the CY Avg for 2017 is an average for the first three months. This allows you to compare similar periods of reimbursement from year to year.
- ROY Avg - (Rest of Year) - This is an average for the months not included in the CY average, hence, the rest of the year.
As we release additional quarters of data, the divide between CY and ROY will progress from three months to six months to nine months. The CY and ROY averages will update at those times so that the periods reported align.