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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
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. (2016). Medicare Payment Basics:
Hospital Acute Inpatient Services Payment System. Available at: http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_hospital_final.pdf
Medicare Payment Advisory Commission. (2014). Medicare Payment Basics: Outpatient Hospital Services Payment System. Available at http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_opd_final.pdf?sfvrsn=0
Medicare Payment Advisory Commission. (2014). Physician and Other Health Professionals Payment System. Available at http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_physician_final.pdf?sfvrsn=0
