Question

Calculate estimated reimbursement for facilities and case mix

In the table below is the listing of Community Hospital’s Top 10 MS-DRGs by Number of Discharges. Determine the MS-DRG weight, total weight and the estimated reimbursement to the facility for each DRG as well as the case mix for this group of MS-DRGs.

Community Hospital has a base rate of $5,750

Go to the Centers for Medicare and Medicaid Services website (Links to an external site.)Links to an external site. for the current weights. Download Table 5 at the bottom of the page. Use information on Table 5 to complete the assignment.

·         Enter the weight of the MS-DRG – use the Table 5 information

·         Multiply the weight by the number of discharges – this gives you the total weight

·         Take the Base Rate for the hospital and multiply that by the weight - - this gives you the estimated revenue for that MS-DRG for an individual patient. – You compute this for the total group of patients.

·         Determine the estimated reimbursement for each MS-DRG.

·         Determine the case mix for this group of patients.

Community Hospital Top 10 MS-DRGs by Discharge
MS-DRG	DRG Name	No. of Discharges	MS-DRG Weight	Total Weight	Total Estimated Reimbursement
73	Cranial & peripheral nerve disorders w MCC	230
114	Orbital procedures w/o CC/MCC	202
135	Sinus & mastoid procedures w CC/MCC	198
154	Other Ear, Nose, Mouth & Throat Diagnoses w MCC	145
163	Major chest procedures w MCC	120
186	Pleural effusion w MCC	103
194	Simple pneumonia & pleurisy w CC	96
207	Respiratory system diagnosis w ventilator support 96+ hours	83

Answer 1

Community Hospital Top 10 MS-DRGs by Discharge
MS-DRG	DRG Name	No. of Discharges	MS-DRG Weight	Total Weight	Total Estimated Reimbursement
73	Cranial & peripheral nerve disorders w MCC	230	13196	303.508	Total estimated rembuirsement based on conversion factor
114	Orbital procedures w/o CC/MCC	202	2,0972	394.506	Total estimated price based on conversion facotr
135	Sinus & mastoid procedures w CC/MCC	198	1.0515	208.197	Total estimated price based on conversion factor
154	Other Ear, Nose, Mouth & Throat Diagnoses w MCC	145	1.4237	206.4365	total estimated price based on conversion factor
163	Major chest procedures w MCC	120	2.5817	309.804	estimated price based on conversion factor
186	Pleural effusion w MCC	103	1.5519	159.8457	estimated price based on conversion factor
194	Simple pneumonia & pleurisy w CC	96	0.9469	90.9024	estimated price based on conversion factor
207	Respiratory system diagnosis w ventilator support 96+ hours	83	5.3364	442.9212	based on conversion factor