Math Problem Payment For Physician And Hospital Services - 1650 Words

Math Problem: Payment For Physician And Hospital Services (Math Problem Sample) Content: Paying for Hospital and Physician ServicesName:Institution:Paying for Hospital and Physician ServicesPart I-Paying for Hospital ServicesMr. 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 transplantWhat 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 a s 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 1.2157From the computation above, the operating payment for Mr. Scotts Kidney transplant is$33,775.139Question 2: Capital payment for kidney transplantWhat 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 Educa tion + 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 1.0874From the computation above, the capital payment to the hospital for Mr. Scotts kidney transplant is $2,661.689Question 3: Hospital medical outlier paymentWill 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. Scotts $ 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 hospitalWhat is the total payment to the hospital?The total amount paid to the hospital for Mr. Scotts kidney transplant is the total sum of the capit al 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 ServicesMr. Robert, a 66-year-old Medicare beneficiary has sought for treatment from Doctor Robinson. After treatment, the cost is shared between Mr. Roberts out-pocket and the Medicare. In order to calculate the payment rate for Dr. Robinsons, the value of products provided in the table below is summed up and then the result is multiplied by the conversion factor.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 Therefore, payment rate= (29.98 + 75.04 + 5.60) x 64.43From the calculation above, the payment rate for Dr. Robinson services is $7,127.247Question 1: Medicare and out-of-pocket amount of payment if Dr. Robinson is a Medicare pa rticipating physicianHow 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?If Dr. Robinson is a Medicare participating physician, the Medicare guidelines clearly states that both the Medicare and patients are catered for fully by the Medicare approved fee for the physician services. In this case Mr. Robert will make an out-pocket payment of 20% of the total bill and Medicare will pay for the remaining charges, that account for 80%.Medicare payment = 80% of 7,127.247From that computation, the Medicare will be responsible for paying Dr. Robinson $5,701.798Mr. Roberts out-of-pocket payment= 20% of 7,127.247From the calculations above, Mr. Robert will have to pay out-of-pocket money amounting to $1,425.449Question 2: Medicare non-participating physician who elect assignmentsHow 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?In a situatio...