Question
6. Using the information below, determine the actual cost for each case for each hospital as well as the MS-DRG payment, and the profit/loss for
6. Using the information below, determine the actual cost for each case for each hospital as well as the MS-DRG payment, and the profit/loss for each case. Based on an evaluation of the results, what would you tell your hospital CFO about the cost effectiveness of treating these types of cases. Keep in mind that these two claims may qualify as high-cost outliers. Based on an evaluation of the results, what would you tell your hospital CFO about the cost effectiveness of treating these types of cases. [Taxonomy level 5 (evaluate)]
20XX Threshold amount = $27,545.00
Hospital Information | |||||||
Hospital | CCR | Base Rate | |||||
Hospital A | 0.547 | $7,300.00 | |||||
Claim Information | |||||||
Claim | MS-DRG | MS-DRG Description | RW | Total Charges | |||
1 | 469 | Major joint replacement or reattachment of lower extremity with MCC | 3.2011 | $139,995.00 | |||
2 | 003 | ECMO or Tracheostomy with MV 96+ hours or PDX excluding face, moth & neck with major OR procedure | 17.6331 | $434,546.55 | |||
Hospital A | |||||||
Claim | Cost | MS-DRG Payment | Fixed-loss cost threshold | Outlier Amount | Total Payment | Profit/Loss | |
1 | |||||||
2 |
Step by Step Solution
There are 3 Steps involved in it
Step: 1
Get Instant Access to Expert-Tailored Solutions
See step-by-step solutions with expert insights and AI powered tools for academic success
Step: 2
Step: 3
Ace Your Homework with AI
Get the answers you need in no time with our AI-driven, step-by-step assistance
Get Started