Paying for hospital and physician services

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:

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 3 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?

Assignment Expectations

Length: The paper should be typed and double spaced, using 12 pt. Times New Roman font and 1-inch page margins. Use headers throughout the paper. This will aid you in not overlooking vital elements of the assignment and make the document easier for the reader to follow. 

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