Chapter 5 - MSDRG Calculations_Class Activity AS
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HSMA 3020
Chapter 5 – MS-DRG Calculations
Class Activity
For this exercise, use the file titled Chapter 5 – MSDRG Calculations.xlsx
, tabs MS-DRG Calculation Example and MS-DRG Calculations. This assignment consists of 10 inpatient acute care admissions; five for Community Hospital and five 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?
The cost-to-charge ratio (CCR) has the biggest impact on estimating profit/loss for an admission because it determines how much it costs the facility to treat a specific encounter. That is then deducted from the MS-DRG reimbursement to determine whether the admission was a 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?
A CC is defined as any diagnosis that would
be listed as the reason for admission. An MCC would be any CC that increases the length of stay or increases the severity of the diagnosis. The CC/MCC code can impact the reimbursement for an admission
in a few ways. One is that the CC/MCC can
increase the severity of the admission, which would increase the reimbursement rate. The presence of an MCC could result in additional time being admitted or result in death, which could have an impact on the reimbursement rate.
Why do surgical cases tend to have a higher relative weight (RW), and in turn payment, than medical cases?
Surgical cases have higher costs because they tend to require more resources, including staff and supplies. What can Memorial Hospital do to improve their profit?
They could reduce their base rates. The best they could do is find a way to lower their CCR. They could also try to reduce
labor-related costs and perform more procedures and surgeries.
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Related Questions
google x S Dallas x B Score X M mybox
com/ilrn/takeAssignment/takeAssignmentMain.do?invoker=&takeAssignmentSession
Calcul x
Ber
eBook
Type of Admission
Unscheduled admission
Scheduled admission
Direct Labor Standards for Nonmanufacturing Expenses
Englert Hospital began using standards to evaluate its Admissions Department. The standard was broken into two types of admissions as follows:
Standard Time to Complete
Admission Record
Print Item
b. What are the standard hours for the actual volume for the week (round to the nearest whole hour)?
hours.
Check My Work
#
30 min.
20 min.
The unscheduled admission took longer because name, address, and insurance information needed to be determined and verified at the time of admission. Information was collected on scheduled admissions
prior to the admissions, which was less time-consuming.
[3
The Admissions Department employs three full-time people (40 productive hours per week, with no overtime) at $15 per hour. For the most recent week, the…
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nment i
Exercise 4-3A (Static)
?Prescription drugs
Lori Garrett is wondering what elements are in a qualified health plan.
Which of the following would be included? (You may select more than one answer. Single click the box with the question me
produce a check mark for a correct answer and double click the box with the question mark to empty the box for a wrong
Any boxes left with a question mark will be automatically graded as incorrect.)
? Preventive and wellness services
?Mental health benefits
? Pet insurance premiums
$
R
%
5
▬
T
G
Q Search
6
B
H
&
7
prt sc
F10
O
(DELL)
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61
He
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Revenue Cycle and Collections
Instructions
The revenue cycle and the phases of the life cycle of patient accounts and collections. select and answer one of the following questions:
1. What are the steps in the revenue cycle?
2. Discuss the collection process
3. Describe the statements, dunning notices, and rules regarding the collection process.
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Objective 4 - Explain how ABC can be simplified.The Bienestar Cardiology Clinic has two major activities: diagnostic andtreatment. The two activities use four resources: nursing, medical technicians,cardiologists, and equipment. Detailed interviews have provided the workdistribution matrix shown
Activity Nursing Technicians Cardiologists Equipmnt Total activity time
Diagnostic 0,7 0,8 0,4 0,6 12.000 hours
Treating 0,3 0,2 0,6 0,4 8.000 hours
Total time 4.000 4.000 6.000 6.000 20.000 hours
Cost 80.000 80.000 320.000 320.000
The total time estimated corresponds to practical capacity (interviewersadjusted the total time to about 80 percent of the available time). Theequipment time is measured in machine hours. Thus, the total time (atpractical capacity) in the system is 20,000 hours. In…
arrow_forward
Objective 4 - Explain how ABC can be simplified.The Bienestar Cardiology Clinic has two major activities: diagnostic andtreatment. The two activities use four resources: nursing, medical technicians,cardiologists, and equipment. Detailed interviews have provided the workdistribution matrix shown
Activity Nursing Technicians Cardiologists Equipmnt Total activity time
Diagnostic 0,7 0,8 0,4 0,6 12.000 hours
Treating 0,3 0,2 0,6 0,4 8.000 hours
Total time 4.000 4.000 6.000 6.000 20.000 hours
Cost 80.000 80.000 320.000 320.000
The total time estimated corresponds to practical capacity (interviewersadjusted the total time to about 80 percent of the available time). Theequipment time is measured in machine hours. Thus, the total time (atpractical capacity) in the system is 20,000 hours. In…
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QUESTION 10
With a DRG, Medicare pays for a hospitalization based on _____.
how long the patient was hospitalized
the diagnosis the patient was hospitalized to treat
how much the hospital did to treat the patient
how much the hospital spent caring for the patient.
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Required:
Record the payment that Mookie The Beagle Concierge receives from Sandy Copper in payment for services provided Remy.
1. Create Receive Payment.
a. From the Navigation Bar, select Projects > Sandy Copper: Remy
b. From the Add to project menu, select Receive payment
c. Select Payment Date: 01/23/2023
d. Select Payment Method: Check
e. Select Deposit to: 1600 Undeposited Funds
f. Select Invoice Number 1002
g. After selecting the Invoice, what is the Amount Received displayed?
Note: Answer this question in the table shown below. Round your answer 2 decimal places.
h. Select Save and close
Amount received
$
2. View the Transaction Journal for Receive Payment.
a. From the Navigation Bar, select Sales > All Sales tab
b. From the Sales Transactions List, select the Sandy Copper: Remy payment just entered
c. From the bottom of Receive Payment, select More > Transaction Journal
d. What are the Account and Amount Debited?
Debit
Credit
20.00
Note: Answer this question in the table shown…
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Q Search
References
Review
View
Help
Tell me what you want to do
O Editing
I U Dv Av .….
11
A
A B
出<=<三v|
Use the following information to answer questions #1-4
Mrs. Smith has a monthly payment of $230 for health insurance, a $500 deductible, an 80%/20% co-
insurance and co-payments of $15 for prescriptions and $45 for office visits.
1.
What is Mrs. Smith's premium?
a.
$45
b. $230
C.
$500
d. $1,000
2.
What amount will Mrs. Smith have to pay for medical services before the policy begins to pay?
a.
$45
b.
$230
C.
$500
d. $1,000
r for a small nrocedure costing $1,000 what percentage of the me
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0
0
The marketing message of a successful procedure should always..
slightly exaggerate
mention patients' names
keep expectations high to remove anxiety
be truthful
The reputation of excellence directly connected to a facility's name is an
Obranding reaction
O marketing ploy
educational approach.
O advertisement
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Table 7. Twenty leading principal reasons for outpatient department visits: the United States, 2009
All visits ... 96,132 Progress visit, not otherwise specified:9,052 General medical examination: 5,762 Cough: 2,638 Counseling, not otherwise specified: 2,550Prenatal examination, routine: 2,410 Medication, other and unspecified kinds: 2,282 Symptoms referable to throat: 1,773 Back symptoms : 1,630 Postoperative visit: 1,593 Diabetes mellitus : 1,568 Fever: 1,341 Knee symptoms: 1,331 Earache or ear infection: 1,326 Stomach pain, cramps and spasms: 1,231 Well-baby examination: 1,198 Headache, pain in head: 1,091 Low back symptoms: *1,078 Hypertension: 1,078 Skin rash: 1,053
Gynecological examination: 1,032 All other reasons ... 53,115
Table 9. Twenty leading principal reasons for office visits, by patient’s sex: the United States, 2018The principal reason for the visit All visits . . . . .860,386 (37,935) Progress visit, not otherwise specified . . . 151,669General medical…
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STAND AID V
APPLY FOR AID V
COMPLETE AID PROCESS V
MANAGE LOANS
< Return To Module Selection
Check Your Knowledge
Question 2 of 3
Please read the following questions carefully and choose an answer from the choices below
you select an answer, select "Continue."
Check Your Knowledge
Which loan type provides interest subsidy, meaning Department of Education
(ED) pays your interest while you're in school, during your grace period, and
during deferment?
Direct Unsubsidized
Direct Subsidized
None of the above
v Check Answer
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Insurance Rejection
Scenarios
Scenario 1
A
patient brings in a prescription for Singulair 10 mg for the pharmacy to fill,
and decides to wait for their prescription. After obtaining all of the patients
PHI and entering all the data into the computers, the technician proceeds to
enter the prescription and adjudicate a claim to the patients insurance. Upon
submission, the technician receives a rejection message stating that the
patients is over the age of 18 and the insurance formulary requires a prior authorization.
(Certain insurance companies will only cover Singulair for adults if doctors
diagnose the patient with a specific diagnosis, such as Asthma)
a.
What
steps need to be taken to begin the process of resolving the rejection?
b.
Who
do you need to contact or notify, who completes the notification, and how are
the individuals notified?
c.
What
other options might be given and to whom?
d.
How
long should this process take, on average?
Scenario 2
A
patient brings in a prescription…
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Sheffield Corp. uses the percentage-of-receivables basis to record bad debt expense and concludes that 3% of accounts receivable will become
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(a) Prepare the adjusting journal entry to record bad debt expense for the year.
(b) If the allowance for doubtful accounts had a debit balance of $887 instead of a credit balance of $2,864, prepare the adjusting journal entry for
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A Order management
B Eligibility
C Release of Information
D Consent forms
E Claims status
F Payment and remittance advice
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- Objective 4 - Explain how ABC can be simplified.The Bienestar Cardiology Clinic has two major activities: diagnostic andtreatment. The two activities use four resources: nursing, medical technicians,cardiologists, and equipment. Detailed interviews have provided the workdistribution matrix shown Activity Nursing Technicians Cardiologists Equipmnt Total activity time Diagnostic 0,7 0,8 0,4 0,6 12.000 hours Treating 0,3 0,2 0,6 0,4 8.000 hours Total time 4.000 4.000 6.000 6.000 20.000 hours Cost 80.000 80.000 320.000 320.000 The total time estimated corresponds to practical capacity (interviewersadjusted the total time to about 80 percent of the available time). Theequipment time is measured in machine hours. Thus, the total time (atpractical capacity) in the system is 20,000 hours. In…arrow_forwardObjective 4 - Explain how ABC can be simplified.The Bienestar Cardiology Clinic has two major activities: diagnostic andtreatment. The two activities use four resources: nursing, medical technicians,cardiologists, and equipment. Detailed interviews have provided the workdistribution matrix shown Activity Nursing Technicians Cardiologists Equipmnt Total activity time Diagnostic 0,7 0,8 0,4 0,6 12.000 hours Treating 0,3 0,2 0,6 0,4 8.000 hours Total time 4.000 4.000 6.000 6.000 20.000 hours Cost 80.000 80.000 320.000 320.000 The total time estimated corresponds to practical capacity (interviewersadjusted the total time to about 80 percent of the available time). Theequipment time is measured in machine hours. Thus, the total time (atpractical capacity) in the system is 20,000 hours. In…arrow_forwardQUESTION 10 With a DRG, Medicare pays for a hospitalization based on _____. how long the patient was hospitalized the diagnosis the patient was hospitalized to treat how much the hospital did to treat the patient how much the hospital spent caring for the patient.arrow_forward
- Required: Record the payment that Mookie The Beagle Concierge receives from Sandy Copper in payment for services provided Remy. 1. Create Receive Payment. a. From the Navigation Bar, select Projects > Sandy Copper: Remy b. From the Add to project menu, select Receive payment c. Select Payment Date: 01/23/2023 d. Select Payment Method: Check e. Select Deposit to: 1600 Undeposited Funds f. Select Invoice Number 1002 g. After selecting the Invoice, what is the Amount Received displayed? Note: Answer this question in the table shown below. Round your answer 2 decimal places. h. Select Save and close Amount received $ 2. View the Transaction Journal for Receive Payment. a. From the Navigation Bar, select Sales > All Sales tab b. From the Sales Transactions List, select the Sandy Copper: Remy payment just entered c. From the bottom of Receive Payment, select More > Transaction Journal d. What are the Account and Amount Debited? Debit Credit 20.00 Note: Answer this question in the table shown…arrow_forwardwhat is the CPR and SMM for PSA 0.75 and 1.50 in months 1, 10, 20, 30.arrow_forwardHow do I figure out each class medical services and meals and residential amounts pleasearrow_forward
- Q Search References Review View Help Tell me what you want to do O Editing I U Dv Av .…. 11 A A B 出<=<三v| Use the following information to answer questions #1-4 Mrs. Smith has a monthly payment of $230 for health insurance, a $500 deductible, an 80%/20% co- insurance and co-payments of $15 for prescriptions and $45 for office visits. 1. What is Mrs. Smith's premium? a. $45 b. $230 C. $500 d. $1,000 2. What amount will Mrs. Smith have to pay for medical services before the policy begins to pay? a. $45 b. $230 C. $500 d. $1,000 r for a small nrocedure costing $1,000 what percentage of the mearrow_forward0 0 The marketing message of a successful procedure should always.. slightly exaggerate mention patients' names keep expectations high to remove anxiety be truthful The reputation of excellence directly connected to a facility's name is an Obranding reaction O marketing ploy educational approach. O advertisementarrow_forwardTable 7. Twenty leading principal reasons for outpatient department visits: the United States, 2009 All visits ... 96,132 Progress visit, not otherwise specified:9,052 General medical examination: 5,762 Cough: 2,638 Counseling, not otherwise specified: 2,550Prenatal examination, routine: 2,410 Medication, other and unspecified kinds: 2,282 Symptoms referable to throat: 1,773 Back symptoms : 1,630 Postoperative visit: 1,593 Diabetes mellitus : 1,568 Fever: 1,341 Knee symptoms: 1,331 Earache or ear infection: 1,326 Stomach pain, cramps and spasms: 1,231 Well-baby examination: 1,198 Headache, pain in head: 1,091 Low back symptoms: *1,078 Hypertension: 1,078 Skin rash: 1,053 Gynecological examination: 1,032 All other reasons ... 53,115 Table 9. Twenty leading principal reasons for office visits, by patient’s sex: the United States, 2018The principal reason for the visit All visits . . . . .860,386 (37,935) Progress visit, not otherwise specified . . . 151,669General medical…arrow_forward
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