Calculate estimated reimbursement for facilities and case mix In the table below
ID: 242096 • Letter: C
Question
Calculate estimated reimbursement for facilities and case mix
In the table below is the listing of Community Hospital’s Top 10 MS-DRGs by Number of Discharges. Determine the MS-DRG weight, total weight and the estimated reimbursement to the facility for each DRG as well as the case mix for this group of MS-DRGs.
Community Hospital has a base rate of $5,750
Go to the Centers for Medicare and Medicaid Services website (Links to an external site.)Links to an external site. for the current weights. Download Table 5 at the bottom of the page. Use information on Table 5 to complete the assignment.
· Enter the weight of the MS-DRG – use the Table 5 information
· Multiply the weight by the number of discharges – this gives you the total weight
· Take the Base Rate for the hospital and multiply that by the weight - - this gives you the estimated revenue for that MS-DRG for an individual patient. – You compute this for the total group of patients.
· Determine the estimated reimbursement for each MS-DRG.
· Determine the case mix for this group of patients.
Community Hospital
Top 10 MS-DRGs by Discharge
MS-DRG
DRG Name
No. of Discharges
MS-DRG Weight
Total Weight
Total Estimated Reimbursement
73
Cranial & peripheral nerve disorders w MCC
230
114
Orbital procedures w/o CC/MCC
202
135
Sinus & mastoid procedures w CC/MCC
198
154
Other Ear, Nose, Mouth & Throat Diagnoses w MCC
145
163
Major chest procedures w MCC
120
186
Pleural effusion w MCC
103
194
Simple pneumonia & pleurisy w CC
96
207
Respiratory system diagnosis w ventilator support 96+ hours
83
Community Hospital
Top 10 MS-DRGs by Discharge
MS-DRG
DRG Name
No. of Discharges
MS-DRG Weight
Total Weight
Total Estimated Reimbursement
73
Cranial & peripheral nerve disorders w MCC
230
114
Orbital procedures w/o CC/MCC
202
135
Sinus & mastoid procedures w CC/MCC
198
154
Other Ear, Nose, Mouth & Throat Diagnoses w MCC
145
163
Major chest procedures w MCC
120
186
Pleural effusion w MCC
103
194
Simple pneumonia & pleurisy w CC
96
207
Respiratory system diagnosis w ventilator support 96+ hours
83
Explanation / Answer
Community Hospital
Top 10 MS-DRGs by Discharge
MS-DRG
DRG Name
No. of Discharges
MS-DRG Weight
Total Weight
Total Estimated Reimbursement
73
Cranial & peripheral nerve disorders w MCC
230
114
Orbital procedures w/o CC/MCC
202
135
Sinus & mastoid procedures w CC/MCC
198
154
Other Ear, Nose, Mouth & Throat Diagnoses w MCC
145
1.4237
206.4365
total estimated price based on conversion factor
163
Major chest procedures w MCC
120
2.5817
309.804
estimated price based on conversion factor
186
Pleural effusion w MCC
103
1.5519
159.8457
estimated price based on conversion factor
194
Simple pneumonia & pleurisy w CC
96
0.9469
90.9024
estimated price based on conversion factor
207
Respiratory system diagnosis w ventilator support 96+ hours
83
5.3364
442.9212
based on conversion factor
Community Hospital
Top 10 MS-DRGs by Discharge
MS-DRG
DRG Name
No. of Discharges
MS-DRG Weight
Total Weight
Total Estimated Reimbursement
73
Cranial & peripheral nerve disorders w MCC
230
13196 303.508 Total estimated rembuirsement based on conversion factor114
Orbital procedures w/o CC/MCC
202
2,0972 394.506 Total estimated price based on conversion facotr135
Sinus & mastoid procedures w CC/MCC
198
1.0515 208.197 Total estimated price based on conversion factor154
Other Ear, Nose, Mouth & Throat Diagnoses w MCC
145
1.4237
206.4365
total estimated price based on conversion factor
163
Major chest procedures w MCC
120
2.5817
309.804
estimated price based on conversion factor
186
Pleural effusion w MCC
103
1.5519
159.8457
estimated price based on conversion factor
194
Simple pneumonia & pleurisy w CC
96
0.9469
90.9024
estimated price based on conversion factor
207
Respiratory system diagnosis w ventilator support 96+ hours
83
5.3364
442.9212
based on conversion factor
Related Questions
drjack9650@gmail.com
Navigate
Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.