Discussion: Hospital Information

Discussion: Hospital Information

HOPPS/ASC: 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. Determine the OPPS and ASC reimbursement rates for a cataract procedure. Answer the discussion question.

Click and download the exercise and the answer sheet.  Submit answer sheet via blacKboard by or before 11/9/2015

Figure 1: Hospital Information
Bedsize: Teachingstatus: Wage index:.9971

300 beds Non-teaching

Cost to Charge Ratios(CCRs)
RC250 Pharmacy,general 0.408344
RC270 Supplies,general 0.796788
RC271 Nonsterilesupply 0.796788
RC272 Sterilesupply 0.796788

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RC276 Intraocularlens 0.796788
RC301 Chemistry 0.291546
RC312 Pathology,surgical 0.291546
RC360 Operatingroom 0.404314
RC370 Anesthesia 0.321246
RC710 Recoveryroom 0.404314
RC730 EKG 0.38251
RC920 Diagnosticservices 0.88447

Figure 2: Claim Information Hospital OutpatientDepartment

Admitdate 2/20/2015 Dischargedate 2/20/2015
Sex:F Age:70 LOS: 1day

Admitdiagnosis 366.9 Cataract,unspecified
Principaldiagnosis: 366.10 Senile cataract,unspecified
Principalprocedure: 66984 Cataract extraction with IOLinsertion
ChargeDetail
RevenueCode CPT/HCPCSCode CodeDescription Charge
250

$475.25
270

$380.25
271

$1178.18
272

$1297.07
276

$551.00
301 36415 Routine venipuncture $10.00
301 82565 Assay ofcreatinine $33.75
301 84132 Assay ofserum potassium $33.75
301 85014 Hematocrit $34.75
312 88304 Tissue examby pathologist $83.50
360 66984 Cataractextraction w/IOL $801.33
370

$574.00
710

$341.00
730 93005 Electrocardiogram, tracing $124.50
920 90772 Ther/proph/diaginj, sc/im $75.50
TOTALCharges $5,693.83
Medicare beneficiary copaymentamount: $531.88

Figure 3: Claim Information Ambulatory SurgeryCenter

CPT Code:66984 Cataract extractionwith IOL Charges: $2,500.00
Medicare beneficiary copaymentamount: $192.76

Figure 4: Fee Schedule Information (CY 2012; to get current year seewww.cms.gov)

RevenueCode CPT/HCPCS FeeSchedule Amt StatusIndicator
301 36415 $3.00 A
301 82565 $7.26 A
301 84132 $6.51 A
301 85014 $3.35 A

Figure 5: APC Information (CY 2012; to get current year seewww.cms.gov)

RevenueCode CPTCode APC Relative Weight StatusIndicator
312 88304 0343 0.5262 X
360 66984 0246 23.8786 T
730 93005 0099 0.3823 S
920 90772 0436 1.8104 S