Medicare: What Is the Operating Payment to Be Paid to the Hospital - Essay Example

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"Medicare: What Is the Operating Payment to Be Paid to the Hospital" paper calculates the medicare payments for Mrs. Anderson who was hospitalized for Nasal Trauma. Due to complications, she stayed in the hospital for 70 days and received extra medical services…

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Medicare: What Is the Operating Payment to Be Paid to the Hospital

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Subject: Miscellaneous
Type: Essay
Level: Undergraduate
Pages: 2 (500 words)
Downloads: 2
Author: reichmann

Extract of sample "Medicare: What Is the Operating Payment to Be Paid to the Hospital"

The DRG assigned to the case was 72. Federal Rate for Operating Costs = DRG Relative Weight x [(Labor Related Large Urban Standardized Amount x San Francisco CBSA Wage Index) + Nonlabor Related National Large Urban Standardized Amount] x (1 + IME + DSH). Operating Outlier Threshold = {[Fixed Loss Threshold x ((Labor-related portion x San Francisco CBSA Wage Index) + Nonlabor related portion)] x Operating CCR to Total} + Federal Payment with IME and DSH: Capital Cost Payment = 0.7502 x $420.65 x 1.03 x 1.

3185 x (1 + 0.0243 + 0.0631) = $466.02Cost Determination:Billed Charges $125,000Operating Cost to Charge Ratio 0.45Operating Costs = (Billed Charges x Operating Cost to Charge Ratio) = $125,000 x 0.45 = $56,250Capital Cost to Charge Ratio 0.06Capital Costs = (Billed Charges x Capital Cost to Charge Ratio) = ($125,000 x .06) = $7,500 Determination of Outlier ThresholdFixed Loss Threshold $24,485Operating CCR to Total CCR = (Operating CCR) / (Operating CCR + Capital CCR) = (0.45) / (0.45 + 0.06) = 0.

8824Operating Outlier Threshold = {[Fixed Loss Threshold x ((Labor-related portion x San Francisco CBSA Wage Index) + Nonlabor related portion)] x Operating CCR to Total} + Federal Payment with IME and DSH: = {[$24,485 x (0.697 x 1.4974) + 0.303] x 0.8824} + $5,811.22 = $25,554.9987 x 0.8824 + $5,811.22 = $28,360.95 Capital CCR to Total CCR = [Capital CCR) / (Operating CCR + Capital CCR)] = (.06) / (.45 + .06) = 0. 1176Capital Outlier Threshold = (Fixed Loss Threshold x Geographic Adj. Factor x Large Urban Add-On x Capital CCR to Total CCR) + Federal Payment with IME and DSH.

Calculate the out-of-pocket payments that Mrs. Anderson will be responsible for. This needs insurance data for Mrs. Anderson. This data is not present here. The question is what is her policy and what is her premium? However, the difference of $125,000 –($94,371.30 + $19,187.70) = $11,441 needs to be paid out-of-pocket from Mrs. Anderson.

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