Module 4 case assignment | MHM 502

Paying for Hospital and Physician Services

Case Assignment

Part I – Paying for Hospital Services – Overview

Mr. Scott is a 69-year-old hospitalized for a Permanent Cardiac Pacemaker procedure. Hillcrest Hospital is a large urban hospital in Cleveland that incurred $150,000 in Medicare-approved charges for treating Mr. Scott. Use the information provided in this module as well as the Hospital Payments Example, found in the Course Table of Contents under the Presentation section, to answer the Case 4 assignment questions. Include all formulas and calculations in your paper.

DRG

Description

Case Weight

115

Permanent Cardiac Pacemaker

3.5513

302

Kidney Transplant

4.1370

441

Hand Procedure/Surgery

0.8785

Part I – Assignment

Answer (in about 3 pages) the following questions for Kidney Transplant only:

What is the operating payment to be paid to the hospital?
What is the capital payment to be paid to the hospital?
Will the hospital be eligible for the Medicare outlier payment?
What is the total payment to the hospital?

Part II – Paying for Physician Services – Overview

Mr. Roberts is a 66-year-old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:

Assignment Expectations

Length: The paper should be typed and double spaced, using 12 pt. Times New Roman font and 1-inch page margins. Use headers throughout the paper. This will aid you in not overlooking vital elements of the assignment and make the document easier for the reader to follow.

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