Chapter 5 - MSDRG Calculations_Class Activity AS
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HSMA 3020
Chapter 5 – MS-DRG Calculations
Class Activity
For this exercise, use the file titled Chapter 5 – MSDRG Calculations.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 (CCR) has the biggest impact on estimating profit/loss for an admission because it determines how much it costs the facility to treat a specific encounter. That is then deducted from the MS-DRG reimbursement to determine whether the admission was a profit or a loss. What is the definition of a CC/MCC? How does the presence of a CC/MCC code impact the reimbursement for an admission?
A CC is defined as any diagnosis that would
be listed as the reason for admission. An MCC would be any CC that increases the length of stay or increases the severity of the diagnosis. The CC/MCC code can impact the reimbursement for an admission
in a few ways. One is that the CC/MCC can
increase the severity of the admission, which would increase the reimbursement rate. The presence of an MCC could result in additional time being admitted or result in death, which could have an impact on the reimbursement rate.
Why do surgical cases tend to have a higher relative weight (RW), and in turn payment, than medical cases?
Surgical cases have higher costs because they tend to require more resources, including staff and supplies. What can Memorial Hospital do to improve their profit?
They could reduce their base rates. The best they could do is find a way to lower their CCR. They could also try to reduce
labor-related costs and perform more procedures and surgeries.
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google x S Dallas x B Score X M mybox
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Type of Admission
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Scheduled admission
Direct Labor Standards for Nonmanufacturing Expenses
Englert Hospital began using standards to evaluate its Admissions Department. The standard was broken into two types of admissions as follows:
Standard Time to Complete
Admission Record
Print Item
b. What are the standard hours for the actual volume for the week (round to the nearest whole hour)?
hours.
Check My Work
#
30 min.
20 min.
The unscheduled admission took longer because name, address, and insurance information needed to be determined and verified at the time of admission. Information was collected on scheduled admissions
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Treating 0,3 0,2 0,6 0,4 8.000 hours
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Use the following information to answer questions #1-4
Mrs. Smith has a monthly payment of $230 for health insurance, a $500 deductible, an 80%/20% co-
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1.
What is Mrs. Smith's premium?
a.
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2.
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a.
$45
b.
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Item 5
Item 5 5 points Item Skipped
The information below pertains to the retiree health care plan of Thompson Technologies:
($ in 000s)
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$
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0
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(510
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158
Net gain–AOCI
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)
(64
)
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FILE
НОМЕ
INSERT
PAGE LAYOUT
FORMULAS
DATA
REV
H11
B
G
1 Exercise Pro
2 2018 Regional Sales to Health Clubs
Quarter 1 Quarter 2 Quarter 3 Quarter 4 Total
of Total
4 Northeast 275794.5 183555.3 282555.3 226634.9
5 Southeast 626898.1 133106.8 243106.8 155574.8
6 West
394216.7 266774.1 186774.1
291697
7 Total Sales
8.
6.
10
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