-Paying for Hospital and Physician Services

MHM502-m4c-Paying for Hospital and Physician Services

Order Description

PAYING FOR HOSPITAL AND PHYSICIAN SERVICES
Assignment-Two Parts total 4 pages
Part I – 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 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
Part I – Assignment
Answer (in about 2 pages) 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?

Part II – Paying for Physician Services – Overview
Mr. Roberts is a 66-year-old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:
Categories RVU Geographic Cost Index Product
Work 27.45 1.092 29.98
Practice Expense 43.05 1.743 75.04
Malpractice 10.32 0.543 5.60
Conversion Factor: 64.43
Part II – Assignment
Please answer in about 2 pages the following questions:
1. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare participating physician? How much out-of-pocket payment will Mr. Roberts be responsible for?
2. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who elects assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
3. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
Required Reading-will upload rest
4. Part I – Paying for Hospital Services
5. Medicare Payment Advisory Commission. (2014). Medicare Payment Basics:
Hospital Acute Inpatient Services Payment System. Available at: https://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_hospital_finalecfc0fadfa9c665e80adff00009edf9c.pdf?sfvrsn=0
6. Medicare Payment Advisory Commission. (2014). Medicare Payment Basics: Outpatient Hospital Services Payment System. Available at https://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_opd_final.pdf?sfvrsn=0
7. Centers for Medicare and Medicaid. (2010). Hospital Outpatient Prospective Payment System. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at https://www.cms.gov/MLNProducts/downloads/HospitalOutpaysysfctsht.pdf (Retrieved 11/21/2012)
8. Centers for Medicare and Medicaid. (2009). Acute Care Hospital Inpatient Prospective Payment System. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at https://www.cms.gov/MLNProducts/downloads/AcutePaymtSysfctsht.pdf (Retrieved 11/21/2012)
9. Medicare Payment Advisory Commission. (2014). Physician and Other Health Professionals Payment System. Available at https://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_physician_final.pdf?sfvrsn=0
10. Centers for Medicare and Medicaid. (2014). Medicare Physician Fee Schedule. The Medicare Learning Network Payment Systems Fact Sheet Series. Available at https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/MedcrephysFeeSchedfctsht.pdf