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-for-Serv ice-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. MCR Rates from Table go in Column I Final Project 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? CHARGE CODE CODE DESCRIPTION CPT CODE REV CODE REVENUE AREA CHARGE MEDICARE VOL TPP Reimb*.62 MCR Reimb TPP VOL 49210 BIOPSY BREAST 1ST LESION STRTCTC 19081 320 1137 2980.8 56 150 49211 BIOPSY BREAST ADD LESION STRTCTC 19083 320 1137 2980.8 56 160 49212 BIOPSY BREAST 1ST LESION STRTCTC 19085 320 1137 2980.8 23 101 49213 BIOPSY BREAST PERCUT W/O IMAGING GUIDANCE 19100 360 1137 826.8 58 115 49214 BIOPSY OF BREAST, OPEN 19101 360 1137 3944.25 37 76 49217 CRYOSURG ABLATE FIBROADENOMA, EACH 19105 360 1137 6059.85 21 32 49218 NIPPLE EXPLORATION 19110 360 1137 3944.25 12 14 49219 EXCISE BREAST DUCT FISTULA 19112 360 1137 3944.25 14 17 49220 REMOVAL OF BREAST LESION 19120 360 1137 3944.25 76 87 49221 EXCISION, BREAST LESION 19125 360 1137 3944.25 45 90 49223 REMOVAL OF CHEST WALL LESION 19260 360 1137 3076.44 22 43 49227 PLACE BALLOON CATHETER FOR RADIOELEMENT AP 19296 360 1137 10810.92 5 24 49229 PLACE BRACHYTHERAPY CATHETER 19298 360 1137 10810.92 10 32 49230 REMOVAL OF BREAST TISSUE 19300 360 1137 3944.25 21 68 49231 PARTIAL MASTECTOMY 19301 360 1137 3944.25 24 45 49232 P-MASTECTOMY W LYMPHADENECTOMY 19302 360 1137 7608.72 21 65 49233 MASTECTOMY, SIMPLE, COMPLETE 19303 360 1137 6059.85 18 47 49234 MASTECTOMY, SUBCUTANEOUS 19304 360 1137 6059.85 17 56 49235 MASTECTOMY, MODIFIED RADICAL 19307 360 1137 7608.72 15 63 49236 SUSPENSION OF BREAST 19316 360 1137 6059.85 11 2 49237 REDUCTION OF LARGE BREAST 19318 360 1137 7608.72 9 12 49238 ENLARGE BREAST 19324 360 1137 7608.72 0 23 49239 ENLARGE BREASE WITH IMPLANT 19325 360 1137 10810.92 0 25 49240 REMOVAL OF BREAST IMPLANT 19328 360 1137 6059.85 5 13 49241 REMOVAL OF BREAST IMPLANT MATERIAL 19330 360 1137 6059.85 0 16 49242 IMMEDIATE BREAST PROSTHESIS 19340 360 1137 7608.72 0 34 49243 DELAYED BREAST PROSTHESIS 19342 360 1137 10810.92 17 27 49244 BREAST RECONSTRUCTION 19350 360 1137 3944.25 4 47 49245 CORRECT INVERTED NIPPLE(S) 19355 360 1137 6059.85 0 3 49246 BREAST RECONSTRUCTION 19357 360 1137 10810.92 6 25 49247 BREAST RECONSTRUCTION 19366 360 1137 6059.85 7 24 49248 SURGERY OF BREAST CAPSULE 19370 360 1137 6059.85 5 12 49249 REMOVAL OF BREAST CAPSULE 19371 360 1137 6059.85 6 9 49250 REVISE BREAST RECONSTRUCTION 19380 360 1137 7608.72 4 8 49251 DESIGN CUSTOM BREAST IMPLANT 19396 360 1137 6059.85 0 23 49252 BREAST SURGERY PROCEDURE 19499 360 1137 3944.25 2 1 MCR Cost TPP Cost MCR Profit TPP Profit Overall Overall TPP MCR Profit Profit CHARGE CODE CODE DESCRIPTION CPT CODE REV CODE REVENUE AREA CHARGE MEDICARE VOL TPP Reimb*.62 MCR Reimb TPP VOL 49210 BIOPSY BREAST 1ST LESION STRTCTC 19081 320 1137 2980.8 56 150 49211 BIOPSY BREAST ADD LESION STRTCTC 19083 320 1137 2980.8 56 160 49212 BIOPSY BREAST 1ST LESION STRTCTC 19085 320 1137 2980.8 23 101 49213 BIOPSY BREAST PERCUT W/O IMAGING GUIDANCE 19100 360 1137 826.8 58 115 49214 BIOPSY OF BREAST, OPEN 19101 360 1137 3944.25 37 76 49217 CRYOSURG ABLATE FIBROADENOMA, EACH 19105 360 1137 6059.85 21 32 49218 NIPPLE EXPLORATION 19110 360 1137 3944.25 12 14 49219 EXCISE BREAST DUCT FISTULA 19112 360 1137 3944.25 14 17 49220 REMOVAL OF BREAST LESION 19120 360 1137 3944.25 76 87 49221 EXCISION, BREAST LESION 19125 360 1137 3944.25 45 90 49223 REMOVAL OF CHEST WALL LESION 19260 360 1137 3076.44 22 43 49227 PLACE BALLOON CATHETER FOR RADIOELEMENT AP 19296 360 1137 10810.92 5 24 49229 PLACE BRACHYTHERAPY CATHETER 19298 360 1137 10810.92 10 32 49230 REMOVAL OF BREAST TISSUE 19300 360 1137 3944.25 21 68 49231 PARTIAL MASTECTOMY 19301 360 1137 3944.25 24 45 49232 P-MASTECTOMY W LYMPHADENECTOMY 19302 360 1137 7608.72 21 65 49233 MASTECTOMY, SIMPLE, COMPLETE 19303 360 1137 6059.85 18 47 49234 MASTECTOMY, SUBCUTANEOUS 19304 360 1137 6059.85 17 56 49235 MASTECTOMY, MODIFIED RADICAL 19307 360 1137 7608.72 15 63 49236 SUSPENSION OF BREAST 19316 360 1137 6059.85 11 2 49237 REDUCTION OF LARGE BREAST 19318 360 1137 7608.72 9 12 49238 ENLARGE BREAST 19324 360 1137 7608.72 0 23 49239 ENLARGE BREASE WITH IMPLANT 19325 360 1137 10810.92 0 25 49240 REMOVAL OF BREAST IMPLANT 19328 360 1137 6059.85 5 13 49241 REMOVAL OF BREAST IMPLANT MATERIAL 19330 360 1137 6059.85 0 16 49242 IMMEDIATE BREAST PROSTHESIS 19340 360 1137 7608.72 0 34 49243 DELAYED BREAST PROSTHESIS 19342 360 1137 10810.92 17 27 49244 BREAST RECONSTRUCTION 19350 360 1137 3944.25 4 47 49245 CORRECT INVERTED NIPPLE(S) 19355 360 1137 6059.85 0 3 49246 BREAST RECONSTRUCTION 19357 360 1137 10810.92 6 25 49247 BREAST RECONSTRUCTION 19366 360 1137 6059.85 7 24 49248 SURGERY OF BREAST CAPSULE 19370 360 1137 6059.85 5 12 49249 REMOVAL OF BREAST CAPSULE 19371 360 1137 6059.85 6 9 49250 REVISE BREAST RECONSTRUCTION 19380 360 1137 7608.72 4 8 49251 DESIGN CUSTOM BREAST IMPLANT 19396 360 1137 6059.85 0 23 49252 BREAST SURGERY PROCEDURE 19499 360 1137 3944.25 2 1 MCR Cost TPP Cost MCR Profit TPP Profit Overall Overall TPP MCR Profit Profit