Referral Calculator

The Referral Calculator is a feature available on every referral. It provides an estimated profit margin for each facility on the referral by calculating the expenses and subtracting them from the revenue. This tool provides insight into potential high-cost referrals, allowing for a more informed decision-making process. 

Payor Section

Facilities with access to billing data

Facilities with no access to billing data

Facilities with access to billing data

Primary Payor Type	Choose the referral's payor type. When the payor type is listed on the referral, it will auto populate.  When the payor type is Medicare, or  “No payor”, no other questions will appear. When the payor type is Medicare, it pulls the facilities average budgeted Medicare rate. When this information is not available for a facility, there is a Default Budgeted Medicare Rate that is pulled from the Settings>Referral Tracker>Calculator page.
Payor Name	The dropdown displays all available payors from your billing system associated with the referral’s facilities and the selected payor type. If the payor you need isn't listed, choose "Not Listed" to manually enter the payor name.
Levels	The dropdown displays all available levels from your billing system associated with the selected payor name. If you manually entered a payor name above, you will only be able to input a daily rate. If a level is not listed, select "Manually Enter Daily Rate".

Sometimes, the Payor Name or Level selected on the calculator may not be available for a specific facility. This happens either when the billing system has inconsistencies between the facilities with the payor names or levels, or the billing system is  missing the information. You'll be prompted to enter the missing information for that specific facility.

Facilities with no access to billing data

When a facility doesn't have billing data, you will have to manually enter the payor name and level information.

Any payor information that gets filled out in the calculator, will update the primary payor information listed on the referral.

Ancillaries Section

Medications	Add the medications with their cost and frequency. Any medications flagged as high-cost on the referral will automatically appear. You may need to add or adjust their cost and frequency. For clients that are subscribed to the SNF Metrics Pharmacy Contracts application, simply choose the medication from the dropdown menu, and its cost will automatically get pulled. If the payor type is Medicaid, no medications need to be added as the resident's secondary insurance (typically Part B) will cover.
TPN	Cost is set in the Settings >Referral Tracker>Calculator page.
Therapy	The active rate is pulled for each facility from the Settings>Therapy Rates page. When the rate type is a per minute charge, you will be prompted to enter the average weekly therapy minutes.

Supplies Section

Supplies and their costs are pulled from Settings>Referral Tracker>Calculator page.

Calculation and Expense Breakdown

A separate calculation is performed for each facility based on the selections made in the Payor, Ancillaries, and Supplies sections of the calculator. The profit shown is an estimate of the projected daily cost and not a guaranteed number.  It helps highlight potentially high-cost referrals which may require further investigation.

To understand what may be driving up the cost, click on the "Expense Breakdown" for an itemized list of expenses. The "Standard Cost" represents the facility's cost per day. If no standard cost is defined, the default expense PPD is pulled from the Settings >Referral Tracker>Calculator page. 

Re-calculate Button

Calculations made in the past will not update automatically when changes are made to calculator settings, payor rates, therapy rates or facility standard costs. If you know the underlying data has changed or want to ensure your calculation reflects the latest information, click the Re-calculate button.

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