Applied Sciences Healthcare Homework
CT0752Please see attachments.
a year ago
15
files (2)DRGCALCULATIONS.docx
CopyofAB202019_Ch05_Exercises.xlsx
DRGCALCULATIONS.docx
1. MS-DRG Calculations (Level 4—Analyzing)
For this exercise, use the file titled AB202019_Ch05_Exercises.xlsx Download 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? |
|
|
What is the definition of a CC/MCC? How does the presence of a CC/MCC code impact the reimbursement for an admission |
|
|
Why do surgical cases tend to have a higher relative weight (RW), and in turn payment, than medical cases? |
|
|
What can Memorial Hospital do to improve their profit? |
|
CopyofAB202019_Ch05_Exercises.xlsx
MS-DRG Calculation Example
| Basic MS-DRG Calculations | |||||
| Hospital | Happy Hopsital | Base Rate | $6,200 | ||
| MS-DRG | 387 | Inflammatory bowel disease w/o CC/MCC | |||
| RW | 0.7007 | ||||
| Charges | $ 9,456.82 | ||||
| CCR | 0.429 | ||||
| LOS | 3 | ||||
| MS-DRG Reimbursment | $ 4,344.34 | Multiply the fully adjusted hospital specific base rate × the MS-DRG Relative Weight (RW) | |||
| Cost of the encounter | $ 4,056.98 | Multiply the charges × the cost to charge ration (CCR) | |||
| Profit/Loss | $ 287.36 | Subtract the cost of the encounter from the MS-DRG Reimbursement |
Example: This example shows how to calculate the MS-DRG reimbursment rate for an acute care inpatient admission. The hospital specific base rate we are using for this example includes adjustments for IME, DSH and wage index.
MS-DRG Calculations
| Basic MS-DRG Calculations | |||||||||||||
| Hospital | Community Hopsital | Base Rate | $6,200 | Hospital | Memorial Hospital | Base Rate | $7,300 | ||||||
| MS-DRG | 192 | Chronic obstructive pulmonary disease w/o CC/MCC | MS-DRG | 192 | Chronic obstructive pulmonary disease w/o CC/MCC | ||||||||
| RW | 0.7092 | RW | 0.7092 | ||||||||||
| Charges | $ 15,000.00 | Charges | $17,500.00 | ||||||||||
| CCR | 0.429 | CCR | 0.531 | ||||||||||
| LOS | 3 | LOS | 4 | ||||||||||
| MS-DRG Reimbursment | MS-DRG Reimbursment | ||||||||||||
| Cost of the encounter | Cost of the encounter | ||||||||||||
| Profit/Loss | Profit/Loss | ||||||||||||
| Hospital | Community Hopsital | Base Rate | $6,200 | Hospital | Memorial Hospital | Base Rate | $7,300 | ||||||
| MS-DRG | 190 | Chronic obstructive pulmonary disease w MCC | MS-DRG | 190 | Chronic obstructive pulmonary disease w MCC | ||||||||
| RW | 1.144 | RW | 1.144 | ||||||||||
| Charges | $ 14,975.24 | Charges | $16,578.24 | ||||||||||
| CCR | 0.429 | CCR | 0.531 | ||||||||||
| LOS | 4 | LOS | 5 | ||||||||||
| MS-DRG Reimbursment | MS-DRG Reimbursment | ||||||||||||
| Cost of the encounter | Cost of the encounter | ||||||||||||
| Profit/Loss | Profit/Loss | ||||||||||||
| Hospital | Community Hopsital | Base Rate | $6,200 | Hospital | Memorial Hospital | Base Rate | $7,300 | ||||||
| MS-DRG | 473 | Cervical spinal fusion w/o CC/MCC | MS-DRG | 473 | Cervical spinal fusion w/o CC/MCC | ||||||||
| RW | 2.5124 | RW | 2.5124 | ||||||||||
| Charges | $ 30,245.87 | Charges | $31,674.10 | ||||||||||
| CCR | 0.429 | CCR | 0.531 | ||||||||||
| LOS | 2 | LOS | 2 | ||||||||||
| MS-DRG Reimbursment | MS-DRG Reimbursment | ||||||||||||
| Cost of the encounter | Cost of the encounter | ||||||||||||
| Profit/Loss | Profit/Loss | ||||||||||||
| Hospital | Community Hopsital | Base Rate | $6,200 | Hospital | Memorial Hospital | Base Rate | $7,300 | ||||||
| MS-DRG | 472 | Cervical spinal fusion w CC | MS-DRG | 472 | Cervical spinal fusion w CC | ||||||||
| RW | 3.0415 | RW | 3.0415 | ||||||||||
| Charges | $ 30,384.64 | Charges | $35,384.57 | ||||||||||
| CCR | 0.429 | CCR | 0.531 | ||||||||||
| LOS | 3 | LOS | 3 | ||||||||||
| MS-DRG Reimbursment | MS-DRG Reimbursment | ||||||||||||
| Cost of the encounter | Cost of the encounter | ||||||||||||
| Profit/Loss | Profit/Loss | ||||||||||||
| Hospital | Community Hopsital | Base Rate | $6,200 | Hospital | Memorial Hospital | Base Rate | $7,300 | ||||||
| MS-DRG | 001 | Heart transplant or implant of heart assist system w/MCC | MS-DRG | 001 | Heart transplant or implant of heart assist system w/MCC | ||||||||
| RW | 27.6339 | RW | 27.6339 | ||||||||||
| Charges | $ 315,258.74 | Charges | $330,879.54 | ||||||||||
| CCR | 0.429 | CCR | 0.531 | ||||||||||
| LOS | 35 | LOS | 38 | ||||||||||
| MS-DRG Reimbursment | MS-DRG Reimbursment | ||||||||||||
| Cost of the encounter | Cost of the encounter | ||||||||||||
| Profit/Loss | Profit/Loss |
Instructions: Calculate the MS-DRG reimbursment rate for each case. Notice the changes in base rate for each facility. Remember the hospital specific base rate includes adjustments for IME, DSH and wage index. Once you have completed the calculations, answer the questions in the Student Workbook.
