Paying for Hospital Services
Mrs. Smith is a 70-year-old hospitalized for a Kidney Transplant procedure. General Hospital is a large urban hospital in San Francisco that incurred $150,000 in Medicare-approved charges in treating Mrs. Smith. Use the information provided in this module as well as the Hospital Payments Example, which can be found in the Module 4 Presentation section, to answer the following 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
Answer the following questions for Kidney Transplant only:
1. What is the operating payment to be paid to the hospital?
2. What is the capital payment to be paid to the hospital?
3. Will the hospital be eligible for the Medicare outlier payment?
4. What is the total payment to the hospital?
Medicare Payment Advisory Commission. (2010). Medicare Payment Basics: Hospital Acute Inpatient Services Payment System. Available at http://www.medpac.gov/documents/MedPAC_Payment_Basics_10_hospital.pdf (Retrieved 11/21/2012)
Medicare Payment Advisory Commission. (2010). Medicare Payment Basics: Outpatient Hospital Services Payment System. Available at http://www.medpac.gov/documents/MedPAC_Payment_Basics_10_OPD.pdf (Retrieved 11/21/2012)
Centers for Medicare and Medicaid. (2010). Hospital Outpatient Prospective Payment System. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at http://www.cms.gov/MLNProducts/downloads/HospitalOutpaysysfctsht.pdf (Retrieved 11/21/2012)
Centers for Medicare and Medicaid. (2009). Acute Care Hospital Inpatient Prospective Payment System. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at http://www.cms.gov/MLNProducts/downloads/AcutePaymtSysfctsht.pdf (Retrieved 11/21/2012)
Office for Oregon Health Policy and Research. (2008). Healthcare Payment Reform & Provider Reimbursement: A Summary of Strategies for Consideration by the Oregon Health Fund Board. Available at http://www.oregon.gov/OHPPR/HFB/Delivery/Payment_Reform_Provider_Reimbursement_Paper.pdf?ga=t (Retrieved 11/21/2012)