Reimbursement Assignment

| March 20, 2015

Paper, Order, or Assignment Requirements

Group the five patients, capture their DRG number, the DRG weight and then calculate the reimbursement. Be sure you read the Reimbursement lecture provided to you in Unit 6 before working on this assignment.

Be sure you read the Reimbursement lecture and watch the DRG Calculator Demo provided to you in Unit 6 before working on this assignment. Open the attachment provided here to view the assignment. Group the five patients, capture their DRG number, the DRG weight and then calculate the reimbursement. Once you have completed this assignment, please send it to your instructor as an attachment.

Medicare Reimbursement Assignment

Performance Objectives:
1. List the components of the Medicare reimbursement formula. Briefly discuss each.
2. Calculate the Medicare reimbursement for a set of patients and analyze the situation for optimal reimbursement.
3. Calculate the case-mix index for a given set of patients.

Â Assignment:
1. Using grouping software, calculate the DRG for each case provided (go to http://www.irp.com (Links to an external site.) selecting their DRG Calculator and then select Medicare DRG Calculator.
2. Using the patient information provides and the DRG Calculator, locate the corresponding DRG weight for each case.
3. Calculate the reimbursement “target rate for a hospital in rural Utah and one in a urban setting in Utah. Then calculate the actual reimbursement for each case for a hospital rural Utah and one in a urban setting in Utah.
4. Compare your reimbursement to the total charges listed for each case and answer the discussion questions that follow.
5. Calculate the case-mix index for these cases.

Case #1

 Female 50yo Home ICD-9-CM Code Code Description Principal Diagnosis 682.7 Cellulitis, left foot Secondary Diagnosis 892.1 Infected dog bite 041.10 Staph infection E906.0 External cause: dog bite Principal Procedure 86.22 Wound debridement, foot

Total Charges \$4,214.89
DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________

Case #2

 Male 50yo Home ICD-9-CM Code Code Description Principal Diagnosis 491.21 Acute exacerbation of COPD Secondary Diagnosis 428.0 Congestive Heart Failure 790.29 Borderline Diabetes Mellitus 401.9 Hypertension 414.00 Arteriosclerotic Heart Disease Principal Procedure None

Total Charges \$3,794.25
DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________

Case #3

 Female 50yo Home ICD-9-CM Code Code Description Principal Diagnosis 161.1 Squamous cell carcinoma, supraglottic larynx Secondary Diagnosis 592.0 Nephrolithiasis 531.90 Gastric ulcer 599.70 Hematuria Principal Procedure 30.4 Total laryngectomy with radical neck dissection Secondary Procedure 33.23 Laryngotracheobronchoscopy 43.11 Insertion PEG 45.16 EGD with biopsy 57.32 Cystoscopy

Total Charges \$12,457.79
DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________

Case #4

 Male 50yo Home ICD-9-CM Code Code Description Principal Diagnosis 600.00 Benign Prostatic Hypertrophy Secondary Diagnosis 250.00 NIDDM V12.59 History of CVA 276.1 Hyponatremia Principal Procedure 60.29 Transurethral resection of prostate

Total Charges \$4528.99
DRG____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________

Case #5

 Female 50yo Home ICD-9-CM Code Code Description Principal Diagnosis 434.00 Cerebral thrombosis, middle cerebral artery Secondary Diagnosis 342.90 Left hemiparesis 401.9 Hypertension Principal Procedure 88.42 Carotid angiogram 87.03 CT Brain Scan

Total Charges \$4255.12

DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________

Did the two hospitals lose or make money on each individual case?

Did each of the hospitals lose or make money when all five cases are considered together as a group?

Calculate the case-mix index of the five cases.

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Category: Health Care

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