CA 4 Medicare Essay Example | Topics and Well Written Essays - 750 words

CA 4 Medicare - Essay ExampleThe DRG assigned to the case was 72.Federal Rate for direct Costs = DRG Relative Weight x (Labor Related Large urban Standardized Amount x San Francisco CBSA Wage Index) + Nonlabor Related National Large Urban Standardized Amount x (1 + IME + DSH).Operating Outlier Threshold = Fixed pass Threshold x ((Labor related portion x San Francisco CBSA Wage Index) + Nonlabor related portion) x Operating CCR to hit + Federal Payment with IME and DSH... Capital Cost Payment = 0.7502 x $420.65 x 1.03 x 1.3185 x (1 + 0.0243 + 0.0631) = $466.02Cost DeterminationBilled criminates $125,000Operating Cost to Charge Ratio 0.45Operating Costs = (Billed Charges x Operating Cost to Charge Ratio) = $125,000 x 0.45 = $56,250Capital Cost to Charge Ratio 0.06Capital Costs = (Billed Charges x Capital Cost to Charge Ratio) = ($125,000 x .06)= $7,500Determination of Outlier ThresholdFixed Loss Threshold $24,485Operating CCR to Total CCR = (Operating CCR) / (Operating CCR + Capita l CCR) = (0.45) / (0.45 + 0.06) = 0.8824Operating Outlier Threshold = Fixed Loss Threshold x ((Labor related portion x San Francisco CBSA Wage Index) + Nonlabor related portion) x Operating CCR to Total + Federal Payment with IME and DSH = $24,485 x (0.697 x 1.4974) + 0.303 x 0.8824 + $5,811.22 = $25,554.9987 x 0.8824 + $5,811.22 = $28,360.95 Capital CCR to Total CCR = Capital CCR) / (Operating CCR + Capital CCR) = (.06) / (.45 + .06) = 0.1176Capital Outlier Threshold = (Fixed Loss Threshold x Geographic Adj. Factor x Large Urban addendum x Capital CCR to Total CCR) + Federal Payment with IME and DSH = ($24,485 x