Case Assignment
Part I - Paying for Hospital Services - Overview
Mr. Scott is a 69-year-old hospitalized for a Permanent Cardiac Pacemaker procedure. Hillcrest Hospital is a large urban hospital in Cleveland that incurred $150,000 in Medicare-approved charges for treating Mr. Scott. Use the information provided in this module as well as the Hospital Payments Example, found in the Course Table of Contents under the Presentation section, to answer the Case 4 assignment questions.
Include all formulas and calculations in your paper.
|
DRG
|
Description
|
Case Weight
|
|
115
|
Permanent Cardiac Pacemaker
|
3.5513
|
|
302
|
Kidney Transplant
|
4.1370
|
|
441
|
Hand Procedure/Surgery
|
0.8785
|
Part I - Assignment
Answer the following questions for Kidney Transplant only:
What is the operating payment to be paid to the hospital?
What is the capital payment to be paid to the hospital?
Will the hospital be eligible for the Medicare outlier payment?
What is the total payment to the hospital?
Part II - Paying for Physician Services - Overview
Mr. Roberts is a 66-year-old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:
|
Categories
|
RVU
|
Geographic Cost Index
|
Product
|
|
Work
|
27.45
|
1.092
|
29.98
|
|
Practice Expense
|
43.05
|
1.743
|
75.04
|
|
Malpractice
|
10.32
|
0.543
|
5.60
|
|
Conversion Factor: 64.43
|
Part II - Assignment
Please answer in about 3 pages the following questions:
How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare participating physician? How much out-of-pocket payment will Mr. Roberts be responsible for?
How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who elects assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?