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Determining monthly rates in long term care with a variable reimbursement schedule

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by Hanten Day

The attached program uses an algorithm to calculate monthly reimbursement rates for long term care facilities based on each patient's length of stay.

In long term care, the costs associated with a patient's stay are dependent in part on the length of the stay. For example, the charge rate is different during the first 30 days than the rate for the 31st - 60th day, etc. Patients check in and check out at different times during the month, and no two lengths of stay are the same. With such variability, how can you calculate a facility's reimbursement rate for the month of June, for example?

Using only admission dates and discharge dates, this algorithm calculates the reimbursement rate for a facility for a calendar year, or single month. Please note the algorithm may need to be adjusted for leap years.

Presented at a State of Oregon SAS Users Group meeting.

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