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Posted on Sep 28, 2024

answer questions. show how you got there The ED physician, who is not a hospital employee, billed Medicare for the following procedures: . ED visit

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The ED physician, who is not a hospital employee, billed Medicare for the following procedures: . ED visit level 4 (IV) CPT 99284 Apply short arm splint CPT 29125 Treat dislocated shoulder CPT 23650 Repair simple laceration 4 cm CPT 12002 The hospital ED billed Medicare for the following procedures: ED visit level 4 CPT/HCPCS 99284 X-ray of shoulder CPT/HCPCS 73030 X-ray of forearm CPT/HCPCS 73090 Splint forearm CPT/HCPCS 29125 Treatment of shoulder dislocation CPT/HCPCS 23650 Repair laceration 2.6 to 7.5 cm CPT/HCPCS 12002 The orthopedic surgeon billed Medicare for the following procedure: CPT 99202 Office/outpatient visit, new, Level 2 The following information may be useful in answering the questions below: The following Geographic Practice Cost Index (GPCI) values apply when adjusting RVUs to calculate Medicare physician reimbursement: o Work GPCI: 1.00 o Practice Expense (PE) GPCI: 0.947 o Professional Liability (PLI) GPCI: 0.535 The Medicare RBRVS conversion factor for physician reimbursement is $34.61. Further information regarding Medicare RBRVS payments for physicians is contained in the "RBRVS" tab of the attached spreadsheet. The Medicare Hospital OPPS national conversion factor is $84.18 The Medicare hospital wage index for Eugene is 1.175. For some procedures, the hospital receives no payment or reduced payment for multiple procedures performed on the same day, deposing on the Status Indicator for each procedure: Status Indicator J1 or J2: Always or may be paid as part of composite APC. In William's situation, no composite APC is activated. Status Indicator N: Not paid. Status Indicator Q1 or 02: Not paid if performed on the same date as procedure(s) with Status Indicator T Status Indicator T: If performed on the same date as other procedure (s) with Status Indicator T, the highest value T procedure is paid at 100% and other T procedures at 50% each. Further information regarding Medicare Hospital OPPS payments is contained in the "OPPS" tab of the attached spreadsheet. Please answer the following questions: 1. For the ED physician services: a. What are the unadjusted Work, Practice Expense, Professional Liability, and Total (i.e., Work + PE+ PLI) RVUS for each procedure? b. What are the Work, Practice Expense, Professional Liability, and Total RVUS for each procedure, after adjustment for GPCIS? c. What is the Medicare payment for each procedure (i.e., Total adjusted RVUS X RBRVS conversion factor)? d. What is William's Medicare Part 8 coinsurance amount, i.e., 20% of the total ED physician payment? 2. For the hospital ED services: a. What is the hospital's adjusted OPPS conversion factor after adjusting 60% of the national conversion factor for area wages? b. For each procedure, list the HCPCS code, Ambulatory Patient Classification (APC), Status Indicator, and Relative Weight. c. What is the Medicare payment (i.e., adjusted OPPS conversion factor X APC relative weight) for each procedure? Remember that some procedures are not paid or are paid at a reduced rate, because they are performed on the same day. d. What is William's Medicare Part B coinsurance amount, i.e., 20% of the total hospital OPPS payment? 3. For the visit to the orthopedic surgeon: a. What are the unadjusted Work, Practice Expense, Professional Liability, and Total RVUS? b. What are the Work, Practice Expense, Professional Liability, and Total RVUS after adjustment for GPCls? c. What is the Medicare payment for the visit (i.e., Total adjusted RVUS X RBRVS conversion factor)? d. What is William's Medicare Part B coinsurance amount, i.e., 20% of the orthopedic surgeon payment? The ED physician, who is not a hospital employee, billed Medicare for the following procedures: . ED visit level 4 (IV) CPT 99284 Apply short arm splint CPT 29125 Treat dislocated shoulder CPT 23650 Repair simple laceration 4 cm CPT 12002 The hospital ED billed Medicare for the following procedures: ED visit level 4 CPT/HCPCS 99284 X-ray of shoulder CPT/HCPCS 73030 X-ray of forearm CPT/HCPCS 73090 Splint forearm CPT/HCPCS 29125 Treatment of shoulder dislocation CPT/HCPCS 23650 Repair laceration 2.6 to 7.5 cm CPT/HCPCS 12002 The orthopedic surgeon billed Medicare for the following procedure: CPT 99202 Office/outpatient visit, new, Level 2 The following information may be useful in answering the questions below: The following Geographic Practice Cost Index (GPCI) values apply when adjusting RVUs to calculate Medicare physician reimbursement: o Work GPCI: 1.00 o Practice Expense (PE) GPCI: 0.947 o Professional Liability (PLI) GPCI: 0.535 The Medicare RBRVS conversion factor for physician reimbursement is $34.61. Further information regarding Medicare RBRVS payments for physicians is contained in the "RBRVS" tab of the attached spreadsheet. The Medicare Hospital OPPS national conversion factor is $84.18 The Medicare hospital wage index for Eugene is 1.175. For some procedures, the hospital receives no payment or reduced payment for multiple procedures performed on the same day, deposing on the Status Indicator for each procedure: Status Indicator J1 or J2: Always or may be paid as part of composite APC. In William's situation, no composite APC is activated. Status Indicator N: Not paid. Status Indicator Q1 or 02: Not paid if performed on the same date as procedure(s) with Status Indicator T Status Indicator T: If performed on the same date as other procedure (s) with Status Indicator T, the highest value T procedure is paid at 100% and other T procedures at 50% each. Further information regarding Medicare Hospital OPPS payments is contained in the "OPPS" tab of the attached spreadsheet. Please answer the following questions: 1. For the ED physician services: a. What are the unadjusted Work, Practice Expense, Professional Liability, and Total (i.e., Work + PE+ PLI) RVUS for each procedure? b. What are the Work, Practice Expense, Professional Liability, and Total RVUS for each procedure, after adjustment for GPCIS? c. What is the Medicare payment for each procedure (i.e., Total adjusted RVUS X RBRVS conversion factor)? d. What is William's Medicare Part 8 coinsurance amount, i.e., 20% of the total ED physician payment? 2. For the hospital ED services: a. What is the hospital's adjusted OPPS conversion factor after adjusting 60% of the national conversion factor for area wages? b. For each procedure, list the HCPCS code, Ambulatory Patient Classification (APC), Status Indicator, and Relative Weight. c. What is the Medicare payment (i.e., adjusted OPPS conversion factor X APC relative weight) for each procedure? Remember that some procedures are not paid or are paid at a reduced rate, because they are performed on the same day. d. What is William's Medicare Part B coinsurance amount, i.e., 20% of the total hospital OPPS payment? 3. For the visit to the orthopedic surgeon: a. What are the unadjusted Work, Practice Expense, Professional Liability, and Total RVUS? b. What are the Work, Practice Expense, Professional Liability, and Total RVUS after adjustment for GPCls? c. What is the Medicare payment for the visit (i.e., Total adjusted RVUS X RBRVS conversion factor)? d. What is William's Medicare Part B coinsurance amount, i.e., 20% of the orthopedic surgeon payment