CA 4 Medicare Essay Example | Topics and Well Written Essays - 750 words

CA 4 Medicare - Essay Example The DRG assigned to the case was 72. Federal Rate for Operating Costs = DRG Relative Weight x [(Labor Related Large Urban Standardized Amount x San Francisco CBSA Wage Index) + Nonlabor Related National Large Urban Standardized Amount] x (1 + IME + DSH). Operating Outlier Threshold = {[Fixed Loss Threshold x ((Labor related portion x San Francisco CBSA Wage Index) + Nonlabor related portion)] x Operating CCR to Total} + Federal Payment with IME and DSH: .. Capital Cost Payment = 0.7502 x $420.65 x 1.03 x 1.3185 x (1 + 0.0243 + 0.0631) = $466.02 Cost Determination: Billed Charges $125,000 Operating Cost to Charge Ratio 0.45 Operating Costs = (Billed Charges x Operating Cost to Charge Ratio) = $125,000 x 0.45 = $56,250 Capital Cost to Charge Ratio 0.06 Capital Costs = (Billed Charges x Capital Cost to Charge Ratio) = ($125,000 x .06)= $7,500 Determination of Outlier Threshold Fixed Loss Threshold $24,485 Operating CCR to Total CCR = (Operating CCR) / (Operating CCR + Capital CCR) = (0.45) / (0.45 + 0.06) = 0.8824 Operating Outlier Threshold = {[Fixed Loss Threshold x ((Labor related portion x San Francisco CBSA Wage Index) + Nonlabor related portion)] x Operating CCR to Total} + Federal Payment with IME and DSH: = {[$24,485 x (0.697 x 1.4974) + 0.303] x 0.8824} + $5,811.22 = $25,554.9987 x 0.8824 + $5,811.22 = $28,360.95 Capital CCR to Total CCR = [Capital CCR) / (Operating CCR + Capital CCR)] = (.06) / (.45 + .06) = 0.1176 Capital Outlier Threshold = (Fixed Loss Threshold x Geographic Adj. Factor x Large Urban Add-On x Capital CCR to Total CCR) + Federal Payment with IME and DSH: = ($24,485 x