LEPPPS Worksheet IPF PPS: Use the information found gures 1 and 2 (below) and tables 6.7-6.11 from the textbook to complete table 1 in order to determine the IPFPPS reimbursement for this encounter. Bed size: 350 beds Classification: Rural Full Service ED: Yes Figure 1: Facility Information Location: Columbus, Ohio Wage Index: 9806 Per-diem unadjusted rate (RY 2012): $685.01 Figure 2: Claim Information Discharge Date: January 15, 2012 LOS: 14 days Admit Date: January 1, 2012 Patient Age: 62 Principal Diagnosis: 295.34 Secondary Diagnosis: 301.6 Secondary Diagnosis: 250.02 MS-DRG: 885 ECT treatments: 90870 Paraphrenic schizophrenia, chronic with acute exacerbation Dependent personality disorder Uncontrolled diabetes mellitus Psychoses 3 units $294.91 per unit (RY 2012) IPFPPS Payment Determination Steps (Use these steps to complete the tables below.) Step One: Wage index adjust the labor portion of the per-diem rate Step Two: Apply COLA to the non-labor portion of the per-diem rate if applicable Step Three: Add results of step one and step two to determine the wage adjusted per-diem rate Step Four: Apply the patient-level and facility-level adjustments Step Five: Multiply the PPS adjustment factor by the wage adjusted per-diem rate to calculate the adjusted per-diem rate Step Six: Identify whether the facility has a qualifying ED Step Seven: Multiply the adjusted per-diem rate by the LOS adjustment factor for each day of the stay to calculate the per-diem payment amount Step Eight: Sum the per-diem payment amounts calculated for each day of stay Step Nine: Calculate the adjusted ECT amount if applicable Step Ten: Sum payments to calculate IPFPPS reimbursement Total Table 1 Step Methodology One (per-diem rate *.70317* WI) Two If COLA then (per-diem rate.29683 COLA) If non-COLA then (per-diem rate* 29683) Three Sum results of step 1 and step 2 Four Use mini-worksheet A (see below) Five Multiply result of step 3 times result of step 4 Six If full service ED then choose higher Day 1 adjustment in step 7 If not full service ED then choose lower Day 1 adjustment in step 7 Seven Use mini-worksheet B (see below) Eight Sum of day rates calculated in step 7 7 Nine If COLA then (ECT exmt rate 70317 WI)+(ECT excit rate .29683 * COLA)) * units of service If non-COLA then ((ECT gymt rate *.70317 * WI) + (ECT exut rate .29683)) units of service Ten Sum results of step 8 and 9 Mini Worksheet A A. Enter adjustment factor if rural location: B. Enter adjustment factor if teaching facility: C. Enter adjustment factor for DRG: Step Four D. Enter adjustment factor for comorbidity: E. Enter adjustment factor for age: Multiply applicable adjustment factors together to determine PPS adjustment factor: Enter PPS adjustment factor in Table 1 row four. Mini Worksheet B Day Adjustment Factor Adj. Factor adjusted per-diem rate (step 5) Step Seven Day one Day twa Day three Day four Day five Day six Day Seven Day eight Day nine Day ten Day eleven Day twelve Day thirteen Day fourteen 2. IPPS: The top 25 MS-DRGs for Hospital A are provided in the table below. Calculate the case mix index for this MS-DRG set. The 2013 IPPS high-cost outlier threshold is $21,821; the hospital specific CCR is: 0.329, the hospital base rate is $5,200.00 Weighted Average MS.ORG Volume MDC TYPE RW 470 08 SURG 2.0963 MED 392 194 332 295 06 04 0.7375 0.996 MED 247 293 05 05 SURG MED 0.6751 MS-DRG Title Major joint replacement or reattachment of lower extremly w/o MCC Esophagitis, www ws digest disorders wic MCC Simple pneumonia & pleurisy CC Perc din pro W drugetingstent w/ MOC Heart Failure & shock w/o CC/MCC Chest pain Heart Failure & shock w CC Kidney & urinary tract infections w/o MCC Chronic obstructive pulmonary disease w/o CC/MCC Septicemia w/o MV 96 hours w MOC Nutritional & with metabolic disorders w/o MCC Heart failure & shock w MCC 313 292 280 245 233 232 219 05 05 MED MED 0.5617 1.0094 0.781 690 11 MED 192 218 04 MED 18 871 641 213 209 193 MED MED 0.7072 1. AR03 0.692 10 05 291 MED 1.5174 885 312 188 177 MED MED 0.9539 0.7339 05 05 287 195 173 172 MED MED 1.0709 0.7078 04 310 603 Psychoses Syncope & colapio Circulatory disorders except AMI, w card cut w/o MOC Simple pneumonia & pleurisy / CAMCC Cardiac arrhythmia & conduction disorders w/o CC/MCC Celiulitis w/ MCC G.1. hemorrhage wa CC/MCC Chronic obstructive pulmonary disease wc Intracranial hemorrhage or cerebral infarction CC Renal failure wc Pulmonary de respiratory failure Transient ischemia Intracranial hemorrhage or cerebral infarction w/o CC/MCC Total CMI 171 143 137 131 05 09 06 04 MED MED MED MED 0.5541 0.8392 0.7015 0.9521 379 191 01 11 065 683 189 069 128 116 114 110 MED MED MED MED 1.1345 0.9868 1.2461 0.7449 04 01 066 102 01 MED 0.8135