Packet D Community General Hospital Community General Hospital has had a long history of aggressive Accounts Receivable Management and wants to see that history continued. From the information listed below you should be able to project the exact revenues that will be generated to support the expenses that have been forecasted in the budget. As a class we will determine the exact profitability of Community General Hospital and what choices will be available as the institution moves forward.

Payer Mix Projected for 2014-2015.

Medicare 44%

Blue Cross 15%

Medicaid 07%

Other Insurance 10%

Self Pay 05%

HMO 19%

The hospital has an ALOS of 3.2 and the % breakdown of patients is as follows:

In Patient 45%

Out Patient 55%

The projected Gross Revenue for the fiscal period ended June 30, 2015 is $ 70, 556,000.00.

This can be broken down as follows: In Patient $30,678,567 Out Patient 39,877,433 Total $70,556,000

The projected reimbursement that is generated from each third party payer is as follows:

In Patient Out Patient

Medicare . $ 4,520/case 35% of Charges

Blue Cross 48% of Charges 38%

Medicaid $ 2,890/case . 22 %

Other Insurance 55% of Charges 65%

Self Pay 60% of Charges 60%

HMO $ 1,250/ Pat Day 32%

Your job as a budget reimbursement specialist is to determine the expected reimbursement from each of the different reimbursement entities. Once this is done you can then calculate the total amount of reimbursement that is expected.