Instructions: Review the hospital and claim information provided. Calculate the cost, MS-DRG payment, outlier add-on amount, total 2 payment, and profit/loss amount for each claim for each provider. The IPPS high-cost outlier threshold for FY 2018 is $26,601.00 3 Total Points = 100 5 6 7 8 9 Hospital 10 Hospital Al 11 Hospital B 12 Hospital C 13 Hospital D 14 Hospital Information CCR 0.429 $ 0.621 $ 0.429 $ 0.621 s Base Rate 6,200.00 6,200.00 8,000.00 8,000.00 15 16 17 Claim 1 2 3 4 18 Claim Information MS-DRG Description Major joint replacement or reattachment of lower extremity with MCC ECMO or Tracheostomy with MV 96+ hours or PDX excluding face, moth & neck with major OR procedure Simple pneumonia & pleurisy with MCC Spinal fusion except cervical with MCC MS-DRG 469 003 193 459 RW Total Charges 3.2011 $ 50,995.12 17.633 $ 323,546.55 1.3733 $ 75,654.25 6.03771 $ 201,654.82 19 20 21 22 23 Hospital A MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Cost Profit/Loss 24 25 26 27 Claim 1 2 3 4 28 29 TOTAL Profit loss Hospital B MS-DRG Payment Fixed-Hoss cost threshold Outlier Amount Total Payment 30 Cost Claim 1 Profit/Loss 31 32 33 2 3 34 4 35 36 TOTAL Profit loss Hospital C MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment 37 Cost Profit/Loss 38 Claim 1 2 39 40 3 4 41 42 43 TOTAL Profit/loss Hospital D MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment 44 Cost Claim 1 Profit/Loss 45 46 2 3 47 48 4 49 TOTAL Profit loss 50 51 52 Instructions: Review the hospital and claim information provided. Calculate the cost, MS-DRG payment, outlier add-on amount, total 2 payment, and profit/loss amount for each claim for each provider. The IPPS high-cost outlier threshold for FY 2018 is $26,601.00 3 Total Points = 100 5 6 7 8 9 Hospital 10 Hospital Al 11 Hospital B 12 Hospital C 13 Hospital D 14 Hospital Information CCR 0.429 $ 0.621 $ 0.429 $ 0.621 s Base Rate 6,200.00 6,200.00 8,000.00 8,000.00 15 16 17 Claim 1 2 3 4 18 Claim Information MS-DRG Description Major joint replacement or reattachment of lower extremity with MCC ECMO or Tracheostomy with MV 96+ hours or PDX excluding face, moth & neck with major OR procedure Simple pneumonia & pleurisy with MCC Spinal fusion except cervical with MCC MS-DRG 469 003 193 459 RW Total Charges 3.2011 $ 50,995.12 17.633 $ 323,546.55 1.3733 $ 75,654.25 6.03771 $ 201,654.82 19 20 21 22 23 Hospital A MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment Cost Profit/Loss 24 25 26 27 Claim 1 2 3 4 28 29 TOTAL Profit loss Hospital B MS-DRG Payment Fixed-Hoss cost threshold Outlier Amount Total Payment 30 Cost Claim 1 Profit/Loss 31 32 33 2 3 34 4 35 36 TOTAL Profit loss Hospital C MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment 37 Cost Profit/Loss 38 Claim 1 2 39 40 3 4 41 42 43 TOTAL Profit/loss Hospital D MS-DRG Payment Fixed-loss cost threshold Outlier Amount Total Payment 44 Cost Claim 1 Profit/Loss 45 46 2 3 47 48 4 49 TOTAL Profit loss 50 51 52
