PC PRICER FAQs
- Who can I contact with questions regarding the PC Pricer?
a. Questions regarding the PC Pricer should be sent to PCPricers@cms.hhs.gov.
- When will the PC Pricer be released? How do I know what changes have occurred for each PC Pricer release?
a. The PC Pricer is usually available at least 60 days after the start of the quarter to which the update applies.
b. The following files are contained in the zipped file listing. These files summarize changes to each PC Pricer release.
|Provider Type||File Name|
|End Stage Renal Disease Facilities||ESRD_FAQsNChanges.txt|
|Long Term Care Hospital||LTCH_ FAQsNChanges.txt|
- How current is the provider specific file data used for PC Pricer?
a. Data contained in the provider specific files installed in the PC Pricers are approximately three months behind the provider specific file data used in the claims processing payment system.
- Are PC Pricers available for all of the PPS provider types?
a. PC Pricers are available for ESRD, Home Health, Inpatient Hospital, Inpatient Psychiatric, Inpatient Rehabilitation, Term Care Hospitals and Skilled Nursing facilities only. A PC Pricer is not available for the Outpatient Prospective Payment System at this time. However, logic used in this Pricer can be viewed by clicking on "Outpatient PPS Pricer Code" located on the left side of the page.
- What is Fujitsu NetCOBOL? Where can Fujitsu NetCOBOL be found?
a. In order to successfully install and run any of the PC Pricer software ( posted on the CMS website after January 2013 ) including End Stage Renal Disease Facilities (ESRD), Home Health (HHA), Inpatient Facilities (IPPS), Inpatient Psychiatric Facilities (IPF), Inpatient Rehabilitation Facilities (IRF), Long Term Care Hospitals (LTCH) and Skilled Nursing Facilities (SNF), a one-time installation of “Fujitsu NetCOBOL” run time files is required. Instructions for downloading Fujitsu NetCOBOL run time files can be found in section one of the “PC Pricer Download Instructions.”
- b. Fujitsu NetCOBOL run time is packaged and can be found with each zipped PC Pricer file for downloading.
- How do I know which PC Pricer should be downloaded?
a. Select the PC Pricer version that corresponds to the discharge date on the claim.
- Is there a user manual for the PC Pricer? Where is it located?
a. There are PC Pricer manuals for each PC Pricer available. User Manuals for each desired provider type can be found in the "downloads" section for each PC Pricer.
- Does the name of the network or hard drive location where the pricer will be installed matter?
a. The directory can be installed to any drive of choice. However, the directory name of the PC Pricer Software should not be changed. Changing the directory name will generate the following error message, “9< Error Detected On Open Prov File” causing the PC Pricer Software to not run properly.
- Can I change the directory name of the PC Pricer software?
a. The directory name of the PC Pricer Software should not be changed because it will generate the following error message, “9< Error Detected On Open Prov File” causing the PC Pricer Software to not run properly. However, the directory can be installed to any drive of choice.
- I have downloaded the PC Pricer software. Which file should I choose in the file listing?
a. Select the executable file. This file has the “.exe” file extension. Note: The naming convention of the executable file varies by provider type. Use the table below to help identify filenames by provider type. The ‘xxx’ in each filename represents the version number for a specific PC Pricer.
|Provider Type||File Name|
|End Stage Renal Disease Facilities||ESDRVxxx.exe|
|Long Term Care Hospitals||LTDRVxxx.exe|
- Which option should I select when using the PC Pricer application?
a. The following options are available to choose from when accessing the PC Pricer application. Select:
i. "Y" = to calculate a claim
ii. "V" = to view provider specific information
iii. "Q" = to quit and close the program.
- I received the following error message “9< Error Detected On Open Prov File” what should I do?
a. This error message appears when opening the PC Pricer Application and the drive entered was not the same drive where the zipped files are located. To troubleshoot this issue, refer to section two, steps 5-7 of the “PC Pricer Download Instructions.”
- I received the following error message “Invalid Admit Date – Please Correct” what should I do?
a. This error message appears when entering a “bill admit date” into the PC Pricer Application that does not correspond to the discharge date on the claim. To troubleshoot this issue, please refer to the specific provider type “Downloads” section to ensure that the PC Pricer Application that was downloaded corresponds to the discharge date on the claim.
- I received the following error message “No RTC Message Found” what should I do?
a. This error message appears when entering a “provider number” into the PC Pricer application that is invalid. This message will also appear if a provider number has a term date. If using a Medicare provider number that was suspended and has since been reinstated, this error message may appear. Please contact the CMS PC Pricer mailbox at PCPricers@cms.hhs.gov if this error message appears while using the PC Pricer application.
- What should I do if I am unable to locate my provider number in PC Pricer? Does this mean that my claims are not being paid?
a. The PC Pricer is a tool available for use in estimating Medicare payments. It does not contain “real time” data and the payments calculated may not exactly match actual claim payments. The PC Pricer contains a provider file with records listing all Medicare providers at the start of the quarter in which the particular version of PC Pricer was released. Facilities that have recently received their Medicare provider number or had a change of ownership may not be included in the provider file. If you can’t locate a provider number in PC Pricer it DOES NOT mean your claims aren’t being paid.
b. A provider record may be created and added manually to the PC Pricer by following the instructions contained in the “User’s Manual” for a specific provider type. The User’s Manual can be found in the “Downloads” section for each provider type.
- What payment rules are used in estimating a claim payment with PC Pricer?
a. The payment rules used in calculating claim payments can be found in the Federal Register for each specific prospective payment system.
- Can I see the computer source code that calculates claim payments?
a. The Cobol source code for the payment calculation modules and drivers used in both PC and Mainframe Pricers can be viewed by accessing CMS’ Pricer Overview page and clicking on "Pricer Cobol Code Text Files" located on the left side of the page.
- How are pass-through amounts calculated in the Inpatient Prospective Payment System PC Pricer?
a. PC Pricer can be used to estimate pass-through payments. Refer to the "User's Manual" located in the "Downloads" section of the Inpatient PPS PC Pricer page.
- After downloading a recent version of the Inpatient Psychiatric Facility Pricer, I noticed that fields are no longer available to enter diagnosis and procedure codes. Instead, groupings of comorbidities are listed along with an indicator “Y/N.” Is this format correct in the Inpatient Psychiatric Facility Pricer?
a. The Inpatient Psychiatric Facility Pricer is the correct version presented in the current format. The referenced change was made to accommodate the expansion of up to 25 diagnosis codes and up to 25 procedure code fields on claims. The changes that have occurred are also to allow all 17 categories of comorbidities to be entered on a claim versus manually entering each and every diagnosis. This is done with the use of “yes/no” questions presented on the screen.
- After downloading a recent PC Pricer, I received the following error message, “This application has failed to start because F38IPRCT.dll was not found. Re-installing the application may fix this problem” what should I do?
- a. Complete the one-time installation of Fujitsu NetCOBOL to your PC. This installation is required in order to successfully install and run any of the PC Pricer software (posted on the CMS website after January 2013 ) including End Stage Renal Disease Facilities (ESRD), Home Health (HHA), Inpatient Facilities (IPPS), Inpatient Psychiatric Facilities (IPF), Inpatient Rehabilitation Facilities (IRF), Long Term Care Hospitals (LTCH) and Skilled Nursing Facilities (SNF).