chapter 5 workbook

.docx

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Saint Louis Community College *

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Course

201

Subject

Mechanical Engineering

Date

Dec 6, 2023

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docx

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3

Uploaded by wunmmy2000

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Beginner Exercises 1. Key Term Word Search (Level 1—Remembering) Use the clues to determine the key term, then find the key term in the grid.
Intermediate Exercise 1. MS-DRG Calculations (Level 4—Analyzing) For this exercise, use the file titled AB202019_Ch05_Exercises.xlsx, tabs MS-DRG Calculation Example and MS-DRG Calculations. This assignment consists of 10 inpatient acute care admissions; 5 for Community Hospital and 5 for Memorial Hospital. Calculate the MS-DRG reimbursement rate for each admission. Notice the fully adjusted base rate, charges, and cost-to- charge ratio are different for each facility. Remember that the fully adjusted base rate already includes adjustments for IME, DSH, and wage index. Once you have completed the calculations, answer the following questions. Question Answer Which figure has the biggest impact in determining profit/loss for an admission; base rate or cost-to-charge ratio (CCR)? Why? CCR is the bigger impact as these charges can be higher than the base rate. It could lead to an increase in profit or a loss. What is the definition of a CC/MCC? How does the presence of a CC/MCC code impact the reimbursement for an admission CC: Complication or comorbidity – are secondary conditions that have a moderate SOI and impact on resource use. MCC: Major complication or comorbidity – are secondary conditions that have a major or extensive SOI and impact on resource use. It increases the number of resources that are used and can cause an increase to reimbursement amount. Why do surgical cases tend to have a higher relative weight (RW), and in turn payment, than medical cases? The costs are higher for surgical cases as more staff are required, more supplies and resources. What can Memorial Hospital do to improve their profit? Find a way to lower the CCR. Advanced Exercises 1. Prospective Payment System Complexity (Level 5—Evaluating) Medicare payment systems are complex. Locate the Medicare Claims Processing Manual on the CMS website. Choose chapter 3, Inpatient Hospital Billing . Examine the detailed table of contents, review the chapter, and pick a few sections to thoroughly read. Write a short paper that considers the following questions: Do payment systems really need to be this complex to control costs? Payment systems in healthcare, including Medicare's prospective payment systems, are designed to achieve multiple objectives, such as controlling costs, ensuring appropriate
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