Please fill in the highlighted yellow cells for each payer. Hint
- remember that reimbursement methodologies will be unique to each
payer/account type and will tie to either: 1) total charges (Column
G), 2) length of stay (Column F), or 3) service-based case rates
(Columns L/M).
Draw observations from the entire data set given. Please also
provide commentary on each underpayment discovered.
I need help calculating the:
Total Charges
Expected Payment
Potential Underpayment
Rate Type
- Please Fill In The Highlighted Yellow Cells For Each Payer Hint Remember That Reimbursement Methodologies Will Be Uni 1 (251.08 KiB) Viewed 45 times
A B Payer Account · 2 Aetna 3 Aetna 4 Aetna 5 Aetna 6 Aetna 7 Aetna 8 Aetna 9 Aetna 10 Aetna 11 Aetna 12 Aetna 13 Aetna Account Type 1 IP 2 OP 2 IP 3 IP 4 IP 5 IP 7 IP 8 OP 9 OP 10 OP 11 OP 12 OP E Admit Disch 8/15/2017 8/22/2017 7/15/2017 7/16/2017 1/20/2017 1/31/2017 2/25/2017 4/25/2017 3/12/2017 3/14/2017 3/23/2017 5/8/2017 4/1/2017 4/10/2017 7/15/2017 7/16/2017 9/1/2017 9/2/2017 9/21/2017 9/23/2017 9/24/2017 9/25/2017 2/18/2017 2/20/2017 G Total Charges 7 $ 210,237.79 $ 1 $ 8,453.98 $ 11 $ 433,673.04 59 $1,027,205.19 2 S 18,403.22 46 $1,099,386.58 9 1$ 8,453.98 1$ 7,432.14 2$ 12,897.32 1$ 9,892.43 2$ 10,213.89 Length of Stay Expected Actual Potential Payment Payment Underpayment 84,095.12 $76,198.61 $ 3,500.00 $ 3,500.00 $ $ 173,469.22 $ 410,882.08 $ 3,500.00 $ 439,754.63 $ 132,081.02 $ 132,081.02 $ $ $ 3,500.00 $ $ 2,900.00 $ 3,500.00 K % Paid DRG 7,896.51 36% 41% 40% 40% 19% 40% #DIV/0! 0% 47% 0% 29% 34% M N Procedure Description Rate Type (General) 473 Spinal Surgery N/A Observation 454 Spinal Surgery 455 Spinal Surgery 473 Spinal Surgery 455 Spinal Surgery 460 Spinal Surgery N/A Observation N/A Observation N/A Observation N/A Observation N/A Observation