Paying for Hospital and Physician Services

Paying for Hospital and Physician Services

Case Assignment

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 Case 4 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 3 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: