Transcript HI215 Unit 9 Final Assignment

HI215 Final Project
Instructions and Guidance
Final Project: Scenario
• The executive finance team at Anywhere Hospital is
reviewing charge levels for various surgical units.
• The team leader has requested a CDM management
report from the CDM coordinator (You). She would like
the report to include the following:
1. Medicare reimbursement, cost, and profit for procedures
performed during first quarter 20xx (current year).
2. Additionally, she would like third-party payer average
reimbursement, cost, and profit for the same time
period.
Final Project
This is a portion of your spreadsheet in which you will provide all of the
calculations for the columns in red. Definitions include the following:
MCR Reimbursement: Medicare Reimbursement; TPP Reimbursement: Third
Party Payer and then cost, profit, and overall profit based on volume.
Final Project: Formulas and Instructions
• Complete the Excel spreadsheet and provide your
analysis.
1. To obtain the MCR Reimbursement (Medicare):
Locate current Medicare rate for each CPT code on
the most current OPPS Addendum B. Copy the link
below into your Web browser or view in Slide Show:
Visit http://www.cms.gov/Medicare/Medicare-Fee-forService-Payment/HospitalOutpatientPPS/Addendum-A-andAddendum-B-Updates.html to find and download
Addendum B (center of page)
2. Transfer the rate figure from Column “F” to the
correct row on your spreadsheet in Column “I”
Addendum B CMS Table
The CMS Table will open up after you agree to the terms. Take the payment rate from
Column “F” and transfer the dollar amount for the specified HCPCS Code. Be very careful
in transferring the right rates to the right codes on your spreadsheet.
Final Project
MCR Rates from Table go in
Column I
Utilize =F2*.62 for TPP
Reimbursement for Column J
(see instruction 2)
Final Project: Instructions
1. “TPP Reimbursement” (Third Party Payer):
Calculate the TPP Reimbursement using the following
formula in Excel: (=F2*.62) -average reimbursement
rate for TPP Column F (charge multiplied by .62)
Insert the calculated figure in Column J
2. MCR Cost = Charge * RCC.
–
Use the RCC provided in the scenario based on the line
item revenue code
•
•
360 is 0.4043
320 is 0.5267
3. TPP Cost = Charge * RCC. Note: there is no difference
between MCR cost and TPP cost.
Final Project
MCR Cost and TPP Cost = Charge * RCC
Use the RCC provided in the scenario based on the line item Rev Code D
360 is 0.4043 (=F( ) * 0.4043) or 320 is 0.5267 (=F2 * 0.5267)
Insert the calculated figure in both Column K and Column L; they will be the
same.
Final Project
• This is a partially completed table showing the
MCR Cost and TPP Cost. Now you will
calculate profit.
Final Project
1. MCR Profit = MCR Reimbursement – MCR
Cost
2. TPP Profit = TPP Reimbursement – TPP Cost
3. MCR Overall Profit: Multiply profit figures
times volumes provided.
4. TPP Overall Profit: Multiply profit figures
times volumes provided
See following example for formulas
Final Project Instructions
MCR Profit = MCR Reimbursement – MCR Cost: Excel Formula (=I2-K2) for Column M
TPP Profit = TPP Reimbursement – TPP Cost: (=J2-L2) for Column N
Final Project Instructions
To calculate Overall MCR Profit, use Formula (=G2*M2) for Column “O”
To calculate Overall TPP Profit, use Formula (=H2*N2) for Column “P”
Final Project
• This is the completed spreadsheet for the first
two rows of your Assignment. Review
carefully.
Final Project: Analysis
Now that you have completed your spreadsheet, answer
the following questions in a separate Word Document.
Support your answers.
• Are either of the payers profitable for Anytime Hospital
in this outpatient surgical area?
• What are the most profitable Medicare
procedures? Least profitable?
• What are the most profitable Third Party
procedures? Least profitable?
• What would you suggest to the Team Leader for the
CDM Management?