PMPM stand for cost per member per month

Coordination of Benefits (COB)

PMPM COPAY FREQ. PER 1000 COPAY COPAY NET AMOUNT PMPM PMPM CATEGORY ANNUAL UNIT FREQ COST PER 1000 HOSPINPT MEDSURG 376 $1100 MATERNITY 32 $850 MENTAL HEALTH 23 $325 SUBTOTAL 275 18 $125 $125 HOSPIOUTPT SURGERY RADIOLLAB ER SUBTOTAL 82 521 140 $1350 $ 325 $ 330 75 62 PHYSICIANS INPT VISITS NPT SURGERY OUTPT SURGERY OFF CE VISITS SUBTOTAL 225 82 426 $125 1625 225 .. 4250 81 3200 12 OTHER HOME HEALTH DUAGE X-RAY DUE SUBTOTAL 65 730 $225 $140 $375 34 TOTAL CO8-1.75% NETHC. COST PETENTION 133 O Focus MacBook Pro mprovements, choose check for Updates Below is an example of a capitation rate schedule for Oasis Health. You need to calculate the expected costs of servicing the patient population given the data in this schedule. You need to fill in the yellow boxes in the table below and determine the 1. PMPM rate (0.6 points each, 10 points total) 2. Net PMPM (0.6 points each, 10 points total) 3. CoPay. PMPM (0.6 points each, 10 points total) 4. Total Costs of Healthcare benefits expected to be paid (10 points each, 30 points total) 5. Given the COB recoveries of 1.75% - what is the expected healthcare costs of this plan? (10 points) I 6. Expected Mark-Up to cover fixed costs is 13% - what is the required PMPM now? (10 points) 7. If the actual days of medical/surgical inpatient days were 425, how would it impact the Net PMPM for Med/Surg? (10 points) Save and submit the Word file using the Assignment submission link in Brightspace course. PMPM COPAY FREQ. PER 1000 COPAY COPAY NET AMOUNT PMPM PMPM CATEGORY ANNUAL UNIT FREQ COST PER 1000 HOSPINPT MEDSURG 376 $1100 MATERNITY 32 $850 MENTAL HEALTH 23 $325 SUBTOTAL 275 18 $125 $125 HOSPIOUTPT SURGERY RADIOLLAB ER SUBTOTAL 82 521 140 $1350 $ 325 $ 330 75 62 PHYSICIANS INPT VISITS NPT SURGERY OUTPT SURGERY OFF CE VISITS SUBTOTAL 225 82 426 $125 1625 225 .. 4250 81 3200 12 OTHER HOME HEALTH DUAGE X-RAY DUE SUBTOTAL 65 730 $225 $140 $375 34 TOTAL CO8-1.75% NETHC. COST PETENTION 133 O Focus MacBook Pro mprovements, choose check for Updates Below is an example of a capitation rate schedule for Oasis Health. You need to calculate the expected costs of servicing the patient population given the data in this schedule. You need to fill in the yellow boxes in the table below and determine the 1. PMPM rate (0.6 points each, 10 points total) 2. Net PMPM (0.6 points each, 10 points total) 3. CoPay. PMPM (0.6 points each, 10 points total) 4. Total Costs of Healthcare benefits expected to be paid (10 points each, 30 points total) 5. Given the COB recoveries of 1.75% - what is the expected healthcare costs of this plan? (10 points) I 6. Expected Mark-Up to cover fixed costs is 13% - what is the required PMPM now? (10 points) 7. If the actual days of medical/surgical inpatient days were 425, how would it impact the Net PMPM for Med/Surg? (10 points) Save and submit the Word file using the Assignment submission link in Brightspace course