Community Hospital is a 455 bed hospital You are starting to look at your sources of revenue for the next year Assume your hospital's rate is $6743 This includes provisions for the wage index and labor and non labor rate Your top 5 MS DRGs along with the anticipated number of discharges for 2018 are listed below You will need to look up the MS DRG weight for these DRGs on the CMS listing Calculate the projected reimbursement you are scheduled to receive from Medicare Enter your work in the table below MS DRG Description Weight of Discharges Reimbursement 292 Heart Failure w CC 845 470 Major Joint Replacement w o MCC 766 392 Esophagitis, Gastroenteritis and Misc Digestive Disorders w o MCC 573 194 Simple Pneumonia Pleurisy W CC 443 690 Kidney and Urinary Tract Infections w o MCC 343 Total Projected Reimbursement You anticipate the following activity for 2018 for commercial insurance patients Using the price information from Elyria Medical Center , calculate the projected reimbursement you are scheduled to receive from commercial insurance patients prior to negotiating a rate Enter your work in the table below Category Activity Rate Reimbursement Nursery 4,552 days ICU CCU 30,300 days Semi private 124,286 days C sections 276 Normal Labor and Delivery 924 Total Projected Reimbursement What will your gross patient revenue be (2) Gross patient revenue Using the numbers above, you have the following assumptions Assume that your commercial payers have negotiated a 30 discount for their patients (2) Commercial Payer Adjusted Rate Medicare will deny 5 of your reimbursement due to poor coding and billing discrepancies (2) Medicare Adjusted Rate You anticipate providing $300,000 in charity care What is your net patient service revenue based on 1, 2, and 3 above (3) Net Patient Service Revenue Based on past experience, 10 of your net patient service revenue will be uncollectable accounts What is your anticipated net patient service revenue less your allowance for uncollectable accounts for 2018 (3) Net Patient Service Revenue (less allowance for doubtful accounts) If your anticipated expenses for 2018 are $73,500,000, what will your net income or loss be (3) Net Income (Loss) Enter your responses to 7 8 in the designated discussion board threads Discussion Explain what happens to the difference between gross patient revenues (projected reimbursement) and net patient service revenue less allowance for doubtful accounts (actual reimbursement) Where does that money go Justify your response Respond to one of your peers Discussion Consider your top 5 DRGs What can your facility do to maximize the set amount of reimbursement that you will receive Justify your response Respond to one of your peers

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Community Hospital is a 455 bed hospital. You are starting to look at your sources of revenue for the next year. Assume your hospital's rate

Community Hospital is a 455 bed hospital. You are starting to look at your sources of revenue for the next year. Assume your hospital's rate is $6743. This includes provisions for the wage index and labor and non-labor rate. Your top 5 MS-DRGs along with the anticipated number of discharges for 2018 are listed below. You will need to look up the MS-DRG weight for these DRGs on the CMS listing. Calculate the projected reimbursement you are scheduled to receive from Medicare. Enter your work in the table below.

MS-DRG

Description

Weight

# of Discharges

Reimbursement

292

Heart Failure w CC

845

470

Major Joint Replacement w/o MCC

766

392

Esophagitis, Gastroenteritis and Misc Digestive Disorders w/o MCC

573

194

Simple Pneumonia & Pleurisy W CC

443

690

Kidney and Urinary Tract Infections w/o MCC

343

Total Projected Reimbursement

You anticipate the following activity for 2018 for commercial insurance patients. Using the price information from Elyria Medical Center, calculate the projected reimbursement you are scheduled to receive from commercial insurance patients prior to negotiating a rate. Enter your work in the table below

Category

Activity

Rate

Reimbursement

Nursery

4,552 days

ICU/CCU

30,300 days

Semi-private

124,286 days

C-sections:

276

Normal Labor and Delivery

924

Total Projected Reimbursement

What will your gross patient revenue be? (2)

Gross patient revenue

Using the numbers above, you have the following assumptions:

Assume that your commercial payers have negotiated a 30% discount for their patients. (2)

Commercial Payer Adjusted Rate

Medicare will deny 5% of your reimbursement due to poor coding and billing discrepancies. (2)

Medicare Adjusted Rate

You anticipate providing $300,000 in charity care

What is your net patient service revenue based on # 1, 2, and 3 above? (3)

Net Patient Service Revenue

Based on past experience, 10% of your net patient service revenue will be uncollectable accounts. What is your anticipated net patient service revenue less your allowance for uncollectable accounts for 2018? (3)

Net Patient Service Revenue (less allowance for doubtful accounts)

If your anticipated expenses for 2018 are $73,500,000, what will your net income or loss be? (3)

Net Income (Loss)

Enter your responses to # 7 & 8 in the designated discussion board threads.

Discussion: Explain what happens to the difference between gross patient revenues (projected reimbursement) and net patient service revenue less allowance for doubtful accounts (actual reimbursement). Where does that money go? Justify your response. Respond to one of your peers.

Discussion: Consider your top 5 DRGs. What can your facility do to maximize the set amount of reimbursement that you will receive. Justify your response. Respond to one of your peers.