Somebody pleaseeeee help me fill in Hospital A, B, C, D information. I cannot figure out how to do this for the life of me.

Example: This example shows how to calculate the outlier payment for an acute care inpatient admission. The IPPS high-cost outlier threshold for FY 2018 is $26,601.00.

In order to determine if a case qualifies for an outlier payment you must calculate the MS-DRG payment for the encounter and calculate the cost for the encounter. Use the overall inpatient CCR for the facility in question.

In this example the fully adjusted hospital specific base rate is $7,500.00. The CCR is .328.

Outlier Formula:

When the cost of an encounter is greater than the Fixed-loss cost threshold for the encounter then an outlier payment is warranted.

The outlier payment is equal to 80% of the different between the cost of the encounter and the Fixed-loss cost threshold for the encounter.

When the encounter is a burn MS-DRG, then the percentage is increased to 90%.

HospitalHappy HospitalBase Rate$7,500

MS-DRG 25Craniotomy & endovascular intracranial procedures with MCC

RW4.3064

Charges $ 234,253.87

CCR0.328

LOS15

MS-DRG Reimbursement $ 32,298.00Multiply the fully adjusted hospital specific base rate * the MS-DRG Relative Weight (RW)

Cost of the encounter $ 76,835.27Multiply the charges * the cost to charge ration (CCR)

Profit/Loss $ (44,537.27)Subtract the cost of the encounter from the MS-DRG Reimbursement

Fixed-loss cost threshold $ 58,899.00Add the high cost outlier threshold ($26,601) to the MS-DRG Reimbursement amount

Outlier is If the cost of the encounter is greater than the fixed-loss cost threshold then an outlier payment

warrantedis warranted.

If the cost of the encounter is less than the fixed loss cost threshold then an outlier payment

is not warranted.

Difference between threshold and cost $ 17,936.27Subtract the fixed-loss cost threshold from the cost of the encounter

Outlier add-on payment $ 14,349.02Multiply the difference by .80 (80%)

Total payment for the encounter $ 46,647.02Add the MS-DRG Reimbursement to the Outlier add-on payment

Final Profit/Loss $ (30,188.25)Subtract the cost of the encounter from the Total payment for the encounter

Instructions: Review the hospital and claim information provided. Calculate the cost, MS-DRG payment, outlier add-on amount, total payment, and profit/loss amount for each claim for each provider. The IPPS high-cost outlier threshold for FY 2018 is $26,601.00 Hospital Information Hospital CCR Base Rate $ Hospital A 0.4296,200.00 $ Hospital B 0.621 6,200.00 $ Hospital C 0.4298,000.00 $ Hospital D 0.621 8,000.00 Claim Information MS- DRG Claim MS-DRG Description Major joint replacement or reattachment of lower extremity with MCC RW Total Charges $ 3.2011 50,995.12 1 469 ECMO or Tracheostomy with MV 96+ hours or PDX excluding face, moth & neck with major OR procedure 2 003 $ 17.6331 323,546.55 $ 1.3733 75,654.25 $ 6.0377 201,654.82 3 193 Simple pneumonia & pleurisy with MCC 4 459 Spinal fusion except cervical with MCC Hospital A Fixed-loss cost threshold Claim Cost MS-DRG Payment Outlier Amount Total Payment Profit/Loss 1 2 3 4 TOTAL Profit/loss Hospital B Fixed-loss cost threshold Claim Cost MS-DRG Payment Outlier Amount Total Payment Profit/Loss 1 2 3 4 TOTAL Profit/loss Hospital C Fixed-loss cost threshold Claim Cost MS-DRG Payment Outlier Amount Total Payment Profit/Loss 1 2 3 4. TOTAL Profit/loss Hospital D Claim Cost MS-DRG Payment Fixed:os cost threshold Outlier Amount Total Payment Profit loss 1 2 3 4 TOTAL Profit/los