OPPS/ASC Reimbursement Comparison for Cataract Surgery Part I: Use the information found in Figures 1-5 (below) to complete the OPPS payment calculations in Table 1 and the ASC PPS payment calculations in Table 2. The 2015 OPPS conversion factor is $74.17. The 2015 ASC PPS conversion factor is $44.07. Please show work. Figure 1: Hospital Information Bed size: Teaching status: 300 beds Non-teaching Wage index: .9971 Cost to Charge Ratios (CCRs) RC 250 Pharmacy, general 0.408344 RC 270 Supplies, general 0.796788 RC 271 Nonsterile supply 0.796788 RC 272 Sterile supply 0.796788 RC 276 Intraocular lens 0.796788 RC 301 Chemistry 0.291546 RC 312 Pathology, surgical 0.291546 RC 360 Operating room 0.404314 RC 370 Anesthesia 0.321246 RC 710 Recovery room 0.404314 RC 730 EKG 0.38251 RC 920 Diagnostic services 0.88447 Figure 2: Claim Information Hospital Outpatient Department Admit date 2/20/2015 Discharge date 2/20/2015 Sex: F Age: 70 LOS: 1 day Admit diagnosis 366.9 Cataract, unspecified Principal diagnosis: 366.10 Senile cataract, unspecified Principal procedure: 66984 Cataract extraction with IOL insertion Charge Detail Revenue Code CPT/HCPCS Code Code Description Charge 250 $475.25 270 $380.25 271 $1178.18 272 $1297.07 276 $551.00 312 88304 Tissue exam by pathologist 360 66984 Cataract extraction w/IOL $83.50 $2,801.33 370 $574.00 710 $341.00 730 93005 Electrocardiogram, tracing $124.50 920 96372 Ther/proph/diag inj, sc/im $75.50 TOTAL Charges Figure 3: Claim Information Ambulatory Surgery Center $7,881.58 CPT Code: 66984 Cataract extraction with IOL Charges:$3,500.00 TOTAL Charges $3,500.00 Figure 4: OPPS Addendum B (Payment) Information CPT Code Status Indicator* APC APC Relative Weight Copayment Amount 66984 T 233 23.6288 $350.53 88304 Q1 342 0.7318 $10.86 93005 Q1 99 1.0579 $15.70 96372 S 437 0.7218 $10.71 Figure 5: ASC Addendum AA (Payment) Information CPT Code 66984 Status Indicator A2 Relative Weight 21.7976 CMS Payment Amount 80% Payment Rate Copayment Amount 20% Payment Rate Table 1: OPPS Reimbursement Step Methodology Total Adjust for geographic factors A Adjust for complexity of service (complete for each separately payable service) B C D Apply OPPS provisions if applicable NO OUTLIER for this example TOTAL Reimbursement E Table 2: ASC PPS Reimbursement Step Methodology A Adjust for geographic factors B Adjust for complexity of service C TOTAL Reimbursement Total