Assignment: OPPS, ASC reimbursement Assignment: OPPS, ASC reimbursement
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Assignment: OPPS, ASC reimbursement
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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.
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Figure 1: HospitalInformation
| 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 | |
| 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 |
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