Reimbursement Assignment
Paper, Order, or Assignment Requirements
Group the five patients, capture their DRG number, the DRG weight and then calculate the reimbursement. Be sure you read the Reimbursement lecture provided to you in Unit 6 before working on this assignment.
Be sure you read the Reimbursement lecture and watch the DRG Calculator Demo provided to you in Unit 6 before working on this assignment. Open the attachment provided here to view the assignment. Group the five patients, capture their DRG number, the DRG weight and then calculate the reimbursement. Once you have completed this assignment, please send it to your instructor as an attachment.
Medicare Reimbursement Assignment
Performance Objectives:
1. List the components of the Medicare reimbursement formula. Briefly discuss each.
2. Calculate the Medicare reimbursement for a set of patients and analyze the situation for optimal reimbursement.
3. Calculate the case-mix index for a given set of patients.
 Assignment:
1. Using grouping software, calculate the DRG for each case provided (go to http://www.irp.com (Links to an external site.) selecting their DRG Calculator and then select Medicare DRG Calculator.
2. Using the patient information provides and the DRG Calculator, locate the corresponding DRG weight for each case.
3. Calculate the reimbursement “target rate for a hospital in rural Utah and one in a urban setting in Utah. Then calculate the actual reimbursement for each case for a hospital rural Utah and one in a urban setting in Utah.
4. Compare your reimbursement to the total charges listed for each case and answer the discussion questions that follow.
5. Calculate the case-mix index for these cases.
Case #1
| Female 50yo Home | ICD-9-CM Code | Code Description |
| Principal Diagnosis | 682.7 | Cellulitis, left foot |
| Secondary Diagnosis | 892.1 | Infected dog bite |
| 041.10 | Staph infection | |
| E906.0 | External cause: dog bite | |
| Principal Procedure | 86.22 | Wound debridement, foot |
Total Charges $4,214.89
DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________
Case #2
| Male 50yo Home | ICD-9-CM Code | Code Description |
| Principal Diagnosis | 491.21 | Acute exacerbation of COPD |
| Secondary Diagnosis | 428.0 | Congestive Heart Failure |
| 790.29 | Borderline Diabetes Mellitus | |
| 401.9 | Hypertension | |
| 414.00 | Arteriosclerotic Heart Disease | |
| Principal Procedure | None |
Total Charges $3,794.25
DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________
Case #3
| Female 50yo Home | ICD-9-CM Code | Code Description |
| Principal Diagnosis | 161.1 | Squamous cell carcinoma, supraglottic larynx |
| Secondary Diagnosis | 592.0 | Nephrolithiasis |
| 531.90 | Gastric ulcer | |
| 599.70 | Hematuria | |
| Principal Procedure | 30.4 | Total laryngectomy with radical neck dissection |
| Secondary Procedure | 33.23 | Laryngotracheobronchoscopy |
| 43.11 | Insertion PEG | |
| 45.16 | EGD with biopsy | |
| 57.32 | Cystoscopy |
Total Charges $12,457.79
DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________
Case #4
| Male 50yo Home | ICD-9-CM Code | Code Description |
| Principal Diagnosis | 600.00 | Benign Prostatic Hypertrophy |
| Secondary Diagnosis | 250.00 | NIDDM |
| V12.59 | History of CVA | |
| 276.1 | Hyponatremia | |
| Principal Procedure | 60.29 | Transurethral resection of prostate |
Total Charges $4528.99
DRG____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________
Case #5
| Female 50yo Home | ICD-9-CM Code | Code Description |
| Principal Diagnosis | 434.00 | Cerebral thrombosis, middle cerebral artery |
| Secondary Diagnosis | 342.90 | Left hemiparesis |
| 401.9 | Hypertension | |
| Principal Procedure | 88.42 | Carotid angiogram |
| 87.03 | CT Brain Scan |
Total Charges $4255.12
DRG ____________
DRG Wt. _____________
Rural Hospital Reimbursement_____________
Urban Hospital Reimbursement_____________
Did the two hospitals lose or make money on each individual case?
Did each of the hospitals lose or make money when all five cases are considered together as a group?
Calculate the case-mix index of the five cases.
