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?

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