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Reimbursement

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Catalog

  • Introduction to the AHCA FFS to MA Levels Calculator Presentation

  • The AHCA urban provider patient-level MA risk calculator takes three user entered data points to compare the MA plan offered rate for an individual patient with a facility-specific comparable Medicare fee-for-service per-diem rate determined by high or low nursing, therapy, and non-therapy ancillary care needs identified by the Patient Intake or Reassessment MA Risk Classification tool.

  • The AHCA rural provider patient-level MA risk calculator takes three user entered data points to compare the MA plan offered rate for an individual patient with a facility-specific comparable Medicare fee-for-service per-diem rate determined by high or low nursing, therapy, and non-therapy ancillary care needs identified by the Patient Intake or Reassessment MA Risk Classification tool.

  • The AHCA MA patient-level risk calculator requires a provider to know whether they are classified as ‘Urban’ or a ‘Rural’ provider for Medicare payment purposes. For providers that do not know this detail, providers only need to know the county their SNF is located to use this wage index lookup file to quickly find the wage index adjustment factor that applies to the facility.

  • The AHCA Medicare Advantage (MA) Fee for Service to Levels Calculator was developed at member request to permit providers with MA contracts to quickly estimate the per-diem payment rate financial risk associated with: Accepting a new MA admission, and Continuing with a current MA rate, or a MA plan proposed adjusted rate related to a significant change in resident care needs during a stay.

NCAL AHCA