Chapter 5
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MS-DRG Calculations (Level 4—Analyzing)
Associate-level Competency: IV.2. Describe components of revenue cycle management and clinical documentation improvement.
Baccalaureate-level Competency: IV.2. Manage components of the revenue cycle
. For this exercise, use the file titled AB202022_Ch05_Exercises.xlsx
, tabs MS-DRG Calculation Example and MS-DRG Calculations. This assignment consists of 10 inpatient acute care admissions; five for Community Hospital and five for Memorial Hospital. Calculate the MS-DRG reimbursement rate for each admission. Notice the fully adjusted base rate, charges, and cost-to-charge ratio are different for each
facility. Remember that the fully adjusted base rate already includes adjustments for IME, DSH, and wage index. Once you have completed the calculations, answer the following questions.
Question
Answer
Which figure has the biggest impact in determining profit/loss for an admission; base rate or cost-to-charge ratio (CCR)? Why?
The cost-to-charge ratio has the most significant impact in determining profit/loss
for admission since it establishes the cost of the encounter, allowing the MS-DRG reimbursement to decide whether the admission was profitable.
What is the definition of a CC/MCC? How does the presence of a CC/MCC code impact the reimbursement for an admission?
CC = Complication or comorbidity
MCC = Major Complication or comorbidity
The presence of a MCC or CC often indicates a patient who needs more resources; hence, hospitals get reimbursed extra to care for these patients.
Why do surgical cases tend to have a higher relative weight (RW), and in turn payment, than medical cases?
Surgical cases have a higher relative weight
since they are often more resource-
intensive than medical cases.
What can Memorial Hospital do to improve their profit?
Memorial Hospital may increase its profits by increasing its CCR. They may do it by reducing their expenses while charging as much as feasible.
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Related Questions
Milestone #1 – Research Project Overview (Week Two)
Introduction: Provide a brief overview of the research healthcare. Describe the topic you are focusing on and establish the rationale behind your choice. Use the model for introduction on page 111 in Creswell & Creswell.
Purpose: Describe the main topics that you will examine in the context of the survey. You do not need to discuss the specific survey questions here. Rather, focus on the broader topics and themes that you will address in the questionnaire. Creswell & Creswell (2023) discuss this in Chapter 6.
arrow_forward
Suppose that a surgical ward has gathered the following information for four nursing activities and two types of patients:
Treating patients
Providing hygienic care
Responding to requests
Monitoring patients
Required:
Normal
Intensive
Driver
Normal
Treatments
Intensive
Hygienic hours
Requests
Monitoring hours
Patient Category
Normal Intensive
7,900
1. Determine the total nursing costs assigned to each patient category.
Costs Assigned
per patient day
per patient day
4,800
32,000
6,000
8,000
19,100
80,000
72,000
Activity Rate
$4.00
5.00
2. Output is measured in patient days. Assuming that the normal patient category uses 8,000 patient days and the intensive patient
category uses 6,400 patient days, calculate the nursing cost per patient day for each type of patient. Round your answers to the nearest
cent.
2.00
3.00
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please answer within the format by providing formula the detailed workingPlease provide answer in text (Without image)Please provide answer in text (Without image)Please provide answer in text (Without image)
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question 7. Fill in the blank. The following table contains select data concerning several outpatient clinics in a new ambulatory care center at Hope University Hospital. Fill in the missing information
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1. How can social media help a hospital manage the patient experience?
2. Briefly explain the difference between short-term and long-term assets.
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List and describe at least 5 stakeholders in the health care payer system.
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Pareto chart and cost of quality report for a service company
The administrator of Liberty Hospital has been asked to perform an activity analysis of the emergency room (ER). The ER activities include cost of quality and other patient care activities. The lab tests and transportation are hospital services external to the ER for determining external failure costs. The result of the activity analysis is summarized as follows:
Activities
Activity Cost
Patient registration
$ 6,500
Verifying patient information
9,700
Assigning patients
13,000
Searching/waiting for doctor
9,200
Doctor exam
4,900
Waiting for transport
17,500
Transporting patients
16,200
Verifying lab orders
14,500
Searching for equipment
8,200
Incorrect labs
11,300
Lab tests
17,000
Counting supplies
19,000
Looking for supplies
8,200
Staff training
4,800
Total
$160,000
a.
b.
c.
d.
Classify the…
arrow_forward
1. Briefly explain The Information Flow.
2. How can social media help a hospital manage the patient experience?
3. Briefly explain the difference between short-term and long-term assets.
4. What are the major differences in Government Sourcesand Managed Care Source?
5. Explain the two types of disbursements for services.
6. What is the difference between direct and indirect costs? Explain.
arrow_forward
Conclusion on the Eight Basic Ratios Used in Health Care
arrow_forward
Provide a brief explanation of the following: a) the difference between the
ratios mentioned below; b) what each ratio conveys to hospital
administrators; c) which financial statement would you use to get the data
to complete each ratio; and, d) define if you would need any other
information to provide a status of the operation to the hospital COO (Hint:
note that it is the Chief Operations Officer who you are meeting with).
Fixed
Asset
Turnover
=
Total revenue
Net fixed assets
TA turnover =
Total revenue
Total assets
Edit View Insert Format Tools
12pt ✓ Paragraph
$117,476
$119,998
tv
Table
BIU
$117,476
$151,278
MacBook Pro
18
-
0.98 times
= 0.78 times
>
T² V
...
Screenshot
2023-0....00.11 PM 202-
arrow_forward
In the module 5 discussion, you identified a method of prevention for each prevention tier (primary, secondary, and tertiary). This week, you were provided information regarding how public health assesses each the effectiveness of a prevention method. This assessment can be economic or in terms of morbidity or mortality.
Initial Post: At what level of prevention do you observe the best impact on your selected disease? That impact can be cost savings or reduction of disease morbidity or mortality.
Classmate Response #1: Find a student who selected a cost analysis. Reflect on whether or not you observe any of the prevention methods presented by the student in your own community.
Classmate Response #2: Find a student who shared an intervention that explores a reduction in disease morbidity or mortality. Discuss with the student if the effort of the intervention can reach or impact sufficient people to actually have a noticeable impact by the general population.
arrow_forward
CHAPTER 17: FINANCIAL CONDITION ANALYSIS
Homework Problem 5.2
Healthy Medical Center
OPERATING DATA
Net inpatient revenue
Net outpatient revenue
Net patient service revenue
Inpatient operating expenses
Total salaries
Total discharges
Inpatient days
# licensed and staffed beds
Total FTES
Inpatient FTES
OPERATING INDICATOR ANALYSIS
Calculate the following ratios based upon the data above
Profit per Discharge
Net Price per Discharge
Outpatient Revenue %
Occupancy Rate
Average Length of Stay
Inpatient FTES per Occupied Bed
$40,902,330
$26,150,670
$67,053,000
$39,675,260
$18,964,670
Salary per FTE
7,498
34,491
163
496
292
Healthy Medical
Center
Industry Average
$73
$5,965
58.5%
56.6%
4.7
5.6
$33,977
For each ratio, provide a brief ratio analysis and comparative analysis.
Indicator Analysis:
Briefly explain what the indicator means
Comparative Analysis
Indicator Analysis
Comparative Analysis
Indicator Analysis
Comparative Analysis
Indicator Analysis
Comparative Analysis
Indicator Analysis…
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To compute a daily rate that reflected the difference in demands, patients were placed in three categories according to illness severity, and the following annual data were collected:
Cost of Activity
Activity Driver
$ 546,780
2,132,200
441,630
4,185,700
$7,306,310
Activity
Lodging
Monitoring
Feeding
Nursing care
Total
The demands associated with patient severity are also provided:
Severity Patient Days Monitoring Hours Nursing Hours
High
Medium
Low
7,170
10,180
3,680
$
Patient days
Monitoring hours used
Patient days
Nursing hours
High severity
Medium severity
Low severity
15,170
12,030
3,260
133,100
72,900
14,300
Required:
1. Suppose that the costs of daily care are assigned using only patient days as the activity driver (which is also the measure of output). Compute the daily rate using this unit-based approach of cost assignment. If required, round your answer
to the nearest cent.
per day
2. Compute activity rates using the given activity drivers (combine activities with the same…
arrow_forward
Which of the following activity bases would be the most appropriate for food costs of a hospital?
a.quantity of prescriptions filled
b.how many MRI's are taken
c.number of nurses scheduled to work
d.number of patients who stay in the hospital
arrow_forward
Select 3 of the following EDI transactions that are processed in the format established by the Health Insurance Portability and Accountability Act (HIPAA)
A Order management
B Eligibility
C Release of Information
D Consent forms
E Claims status
F Payment and remittance advice
arrow_forward
Define a "new patient" according to the CPT manual.
arrow_forward
Suppose that a surgical ward has gathered the following information for four nursing activities and two types of patients:
Patient Category
Driver
Normal
Intensive
Activity Rate
Treating patients
Treatments
7,400
10,000
$4.00
Providing hygienic care
Hygienic hours
4,800
18,100
5.00
Responding to requests
Requests
32,000
80,000
2.00
Monitoring patients
Monitoring hours
6,000
72,000
3.00
Required:
1. Determine the total nursing costs assigned to each patient category.
Costs Assigned
Normal
Intensive
2. Output is measured in patient days. Assuming that the normal patient category uses 8,000 patient days and the intensive patient category uses 6,400 patient days, calculate the
nursing cost per patient day for each type of patient. Round your answers to the nearest cent.
Normal
per patient day
Intensive
$4
per patient day
3. Conceptual Connection: The supervisor of the surgical ward has suggested that patient days is the only driver needed to assign nursing costs to each type of patient.…
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Describe the accounting treatment
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please answer within the format by providing formula the detailed workingPlease provide answer in text (Without image)Please provide answer in text (Without image)Please provide answer in text (Without image)
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Related Questions
- Milestone #1 – Research Project Overview (Week Two) Introduction: Provide a brief overview of the research healthcare. Describe the topic you are focusing on and establish the rationale behind your choice. Use the model for introduction on page 111 in Creswell & Creswell. Purpose: Describe the main topics that you will examine in the context of the survey. You do not need to discuss the specific survey questions here. Rather, focus on the broader topics and themes that you will address in the questionnaire. Creswell & Creswell (2023) discuss this in Chapter 6.arrow_forwardSuppose that a surgical ward has gathered the following information for four nursing activities and two types of patients: Treating patients Providing hygienic care Responding to requests Monitoring patients Required: Normal Intensive Driver Normal Treatments Intensive Hygienic hours Requests Monitoring hours Patient Category Normal Intensive 7,900 1. Determine the total nursing costs assigned to each patient category. Costs Assigned per patient day per patient day 4,800 32,000 6,000 8,000 19,100 80,000 72,000 Activity Rate $4.00 5.00 2. Output is measured in patient days. Assuming that the normal patient category uses 8,000 patient days and the intensive patient category uses 6,400 patient days, calculate the nursing cost per patient day for each type of patient. Round your answers to the nearest cent. 2.00 3.00arrow_forwardplease answer within the format by providing formula the detailed workingPlease provide answer in text (Without image)Please provide answer in text (Without image)Please provide answer in text (Without image)arrow_forward
- question 7. Fill in the blank. The following table contains select data concerning several outpatient clinics in a new ambulatory care center at Hope University Hospital. Fill in the missing informationarrow_forward1. How can social media help a hospital manage the patient experience? 2. Briefly explain the difference between short-term and long-term assets.arrow_forwardList and describe at least 5 stakeholders in the health care payer system.arrow_forward
- Pareto chart and cost of quality report for a service company The administrator of Liberty Hospital has been asked to perform an activity analysis of the emergency room (ER). The ER activities include cost of quality and other patient care activities. The lab tests and transportation are hospital services external to the ER for determining external failure costs. The result of the activity analysis is summarized as follows: Activities Activity Cost Patient registration $ 6,500 Verifying patient information 9,700 Assigning patients 13,000 Searching/waiting for doctor 9,200 Doctor exam 4,900 Waiting for transport 17,500 Transporting patients 16,200 Verifying lab orders 14,500 Searching for equipment 8,200 Incorrect labs 11,300 Lab tests 17,000 Counting supplies 19,000 Looking for supplies 8,200 Staff training 4,800 Total $160,000 a. b. c. d. Classify the…arrow_forward1. Briefly explain The Information Flow. 2. How can social media help a hospital manage the patient experience? 3. Briefly explain the difference between short-term and long-term assets. 4. What are the major differences in Government Sourcesand Managed Care Source? 5. Explain the two types of disbursements for services. 6. What is the difference between direct and indirect costs? Explain.arrow_forwardConclusion on the Eight Basic Ratios Used in Health Carearrow_forward
- Provide a brief explanation of the following: a) the difference between the ratios mentioned below; b) what each ratio conveys to hospital administrators; c) which financial statement would you use to get the data to complete each ratio; and, d) define if you would need any other information to provide a status of the operation to the hospital COO (Hint: note that it is the Chief Operations Officer who you are meeting with). Fixed Asset Turnover = Total revenue Net fixed assets TA turnover = Total revenue Total assets Edit View Insert Format Tools 12pt ✓ Paragraph $117,476 $119,998 tv Table BIU $117,476 $151,278 MacBook Pro 18 - 0.98 times = 0.78 times > T² V ... Screenshot 2023-0....00.11 PM 202-arrow_forwardIn the module 5 discussion, you identified a method of prevention for each prevention tier (primary, secondary, and tertiary). This week, you were provided information regarding how public health assesses each the effectiveness of a prevention method. This assessment can be economic or in terms of morbidity or mortality. Initial Post: At what level of prevention do you observe the best impact on your selected disease? That impact can be cost savings or reduction of disease morbidity or mortality. Classmate Response #1: Find a student who selected a cost analysis. Reflect on whether or not you observe any of the prevention methods presented by the student in your own community. Classmate Response #2: Find a student who shared an intervention that explores a reduction in disease morbidity or mortality. Discuss with the student if the effort of the intervention can reach or impact sufficient people to actually have a noticeable impact by the general population.arrow_forwardCHAPTER 17: FINANCIAL CONDITION ANALYSIS Homework Problem 5.2 Healthy Medical Center OPERATING DATA Net inpatient revenue Net outpatient revenue Net patient service revenue Inpatient operating expenses Total salaries Total discharges Inpatient days # licensed and staffed beds Total FTES Inpatient FTES OPERATING INDICATOR ANALYSIS Calculate the following ratios based upon the data above Profit per Discharge Net Price per Discharge Outpatient Revenue % Occupancy Rate Average Length of Stay Inpatient FTES per Occupied Bed $40,902,330 $26,150,670 $67,053,000 $39,675,260 $18,964,670 Salary per FTE 7,498 34,491 163 496 292 Healthy Medical Center Industry Average $73 $5,965 58.5% 56.6% 4.7 5.6 $33,977 For each ratio, provide a brief ratio analysis and comparative analysis. Indicator Analysis: Briefly explain what the indicator means Comparative Analysis Indicator Analysis Comparative Analysis Indicator Analysis Comparative Analysis Indicator Analysis Comparative Analysis Indicator Analysis…arrow_forward
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Recommended textbooks for you
- Managerial AccountingAccountingISBN:9781337912020Author:Carl Warren, Ph.d. Cma William B. TaylerPublisher:South-Western College PubFinancial And Managerial AccountingAccountingISBN:9781337902663Author:WARREN, Carl S.Publisher:Cengage Learning,

Managerial Accounting
Accounting
ISBN:9781337912020
Author:Carl Warren, Ph.d. Cma William B. Tayler
Publisher:South-Western College Pub

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ISBN:9781337902663
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Publisher:Cengage Learning,