Sign In
Not register? Register Now!
Essay Available:
Pages:
6 pages/≈1650 words
Sources:
3 Sources
Level:
APA
Subject:
Health, Medicine, Nursing
Type:
Math Problem
Language:
English (U.S.)
Document:
MS Word
Date:
Total cost:
$ 29.16
Topic:

Math Problem: Payment For Physician And Hospital Services (Math Problem Sample)

Instructions:

computing remuneration for physicians and hospitals based on a data given by the client.

source..
Content:


Paying for Hospital and Physician Services
Name:
Institution:
Paying for Hospital and Physician Services
Part I-Paying for Hospital Services
Mr. Scott is a 69-year old hospitalized at Hillcrest Hospital in Cleveland for a permanent cardiac pace maker procedure. The hospital incurred $150,000 as Medicare approved charges for treating him. Below is also a table of DRG for services provided at Hillcrest Hospital. These rates together with the MH4 Hospital payment examples are very useful in calculating the amount that Mr. Scott was supposed to pay for receiving the kidney transplant treatment.
DRG

Description

Case weight

115

Permanent cardiac pacemaker

3.5513

302

Kidney transplant

4.1370

441

Hand procedure/surgery

0.8785

Question 1: Operating payment for kidney transplant
What is the operating payment to be paid to the hospital for kidney transplant?
From the table above, the DRG case weight for kidney transplant is 4.1370, therefore, the computation of the operating system is as follows “DRG Relative Weight x ((Labor Related Large Urban Standardized Amount x Core-Based Statistical Area [CBSA] wage index) + (Non-labor Related National Large Urban Standardized Amount x Cost of Living Adjustment)) x (1+ Indirect Medical Education + Disproportionate Share Hospital)” (Module 4-Home).
Operating payment=4.1370 x (3,397.52x1.5419) + (1,476.97x1) x (1+0.00744+0.1413)
=4.1370x (5,238.636+ 1,476.97) x 1.2157
=4 .1370 x 6,715.606 x 1.2157
From the computation above, the operating payment for Mr. Scotts Kidney transplant is
$33,775.139
Question 2: Capital payment for kidney transplant
What is the capital payment to be paid to the hospital for kidney transplant?
To calculate the capital payment to be paid at the hospital for kidney transplant, the following computation is derived with the help of MH4 Hospital payment figures: “DRG relative Rate x Federal Capital Rate x Large Urban Add-On x Geographic Cost Adjustment Factor x Cost of Living Adjustment x (1+ Indirect Medical Education + Disproportionate Share Hospital)” (Module 4-Home).
Capital payment for kidney transplant= 4.1370 x 427.03 x 1.03 x 1.3 4.1370 x 427.03 x 1.03 x 1.3452 x 1 x (1 + 0.0243+0.0631)
=2447.755 x 1.0874
From the computation above, the capital payment to the hospital for Mr. Scotts kidney transplant is $2,661.689
Question 3: Hospital medical outlier payment
Will the hospital be eligible for the Medicare outlier payment?
According to MEDPAC (2014), “The outlier policy acts as stop-loss insurance” since they are very large amounts that results into losses, which may be costly for the hospital to make up for. Since Mr. Scott's $ 150,000 incurred at the Hillcrest Hospital is Medicare-approved, the bill was fully catered for. That means that the hospital is not qualified for outlier payment for the total bill incurred.
Question 4: Total payment to the hospital
What is the total payment to the hospital?
The total amount paid to the hospital for Mr. Scott's kidney transplant is the total sum of the capital payment for kidney transplant and operating payment.
Therefore, Total payment for kidney transplant = 33,775.139 + 2,661.689
$36,436.828 is the amount that Mr. Scott should pay the hospital for kidney transplant.
Part II: Paying for Physician Services
Mr. Robert, a 66-year-old Medicare beneficiary has sought for treatment from Doctor Robinson. After treatment, the cost is shared between Mr. Robert

...
Get the Whole Paper!
Not exactly what you need?
Do you need a custom essay? Order right now:

Other Topics:

  • Access To Medical Records: Professional Ethics In Health
    Description: Zhou went against the medical ethics by accessing the medical records after he was terminated from the UCLA working system...
    4 pages/≈1100 words| 4 Sources | APA | Health, Medicine, Nursing | Math Problem |
  • Math Problem: Payment For Physician And Hospital Services
    Description: Mr. Scott is a 69-year old hospitalized at Hillcrest Hospital in Cleveland for a permanent cardiac pace maker procedure. The hospital incurred $150,000 as Medicare approved charges for treating him. ...
    6 pages/≈1650 words| 3 Sources | APA | Health, Medicine, Nursing | Math Problem |
Need a Custom Essay Written?
First time 15% Discount!