What is the operating payment to be paid to the hospital for a kidney transplant patient?

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Paying for Hospital Services – Overview

Mr. Scott is a 69-year-old hospitalized for a Permanent Cardiac Pacemaker procedure. Hillcrest Hospital is a large urban hospital in Cleveland that incurred $150,000 in Medicare-approved charges for treating Mr. Scott. Use the information provided in this module as well as the Hospital Payments Example, found in the Course Table of Contents under the Presentation section, to answer the Case 4 assignment questions. Include all formulas and calculations in your paper.

DRG

Description

Case Weight

115

Permanent Cardiac Pacemaker

3.5513

302

Kidney Transplant

4.1370

441

Hand Procedure/Surgery

0.8785

the following questions for Kidney Transplant only:

1. What is the operating payment to be paid to the hospital?

2. What is the capital payment to be paid to the hospital?

3. Will the hospital be eligible for the Medicare outlier payment?

4. What is the total payment to the hospital?

Medicare Payment Advisory Commission. (2016). Medicare Payment Basics:
Hospital Acute Inpatient Services Payment System. Available at: http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_hospital_final.pdf

Medicare Payment Advisory Commission. (2014). Medicare Payment Basics: Outpatient Hospital Services Payment System. Available at http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_opd_final.pdf?sfvrsn=0

Medicare Payment Advisory Commission. (2014). Physician and Other Health Professionals Payment System. Available at http://www.medpac.gov/docs/default-source/payment-basics/medpac_payment_basics_16_physician_final.pdf?sfvrsn=0

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