Note: Please answer Questions 1. 2. 3. and 4 below. Each answer has several parts. As an analyst, you have been asked to

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Note Please Answer Questions 1 2 3 And 4 Below Each Answer Has Several Parts As An Analyst You Have Been Asked To 1 (69.82 KiB) Viewed 43 times

Note: Please answer Questions 1. 2. 3. and 4 below. Each answer has several parts. As an analyst, you have been asked to compare the Medicare reimbursement for inpatient care at 2 hospitals: Southern Hospital is located in a large urban area o The hospital Wage Index for this urban area is 1.05 Southern Hospital's Cost-to-Charge ratio is 0.20 Northern Hospital is located in a small city o The hospital Wage Index for this city is 0.90 o Northern Hospital's Cost-to-Charge ratio is 0.25 1. What is the adjusted MS-DRG base payment amount for each hospital, after adjusting for area wages? • The FY 2022 national base payment amount is $6,595. You have been asked to compare the reimbursement for the following 4 MS-DRGS: MS-DRG Title 194 SIMPLE PNEUMONIA & PLEURISY W CC 226 CARDIAC DEFIBRILLATOR IMPLANT WITHOUT CARDIAC CATHETERIZATION WITH MCC 382 COMPLICATED PEPTIC ULCER W/O CC/MCC 515 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W MCC 2. What is the Medicare reimbursement rate (that is, the MS-DRG payment) for each of these 4 MS-DRGs at each hospital? • Refer to the Excel table of MS-DRGS ("CMS Table 5 2022") for information about each MS-DRG 3. What is the per day or per-diem payment rate (.e., MS-DRG payment/Geometric Mean LOS) for each of these 4 MS-DRGs at each hospital? At Southern Hospital, you are asked to analyze 2 high-cost discharges with DRG 226: • Discharge A has total charges of $428,000 • Discharge B has total charges of $255,000 4. What are Southern Hospital's total costs for Discharge A and for Discharge B? Does either Discharge A or B trigger an outlier payment? If so, what is the amount of the outlier payment for each discharge? NOTE: Show your work so that you may receive partial credit if you make a mistake on a particular step but get other steps correct!