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##### Kaplan HCA 440 HCF Unit 3 Study Exam questions

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Question;Dr. Melissa Rose is trying to decide;whether to be a Medicare-participating physician for the upcoming year. (Assume;that her entire practice consists of Medicare patients or at least that her;practice has slack capacity. Her Medicare patients do not displace non-Medicare;patients.) Assume that her average charge is \$120 (before Medicare?s limiting;charge is applied), for which the average Medicare-approved amount is \$100. If;she decides to be a non-participating physician, she expects to accept assignment;80% of the time. For the unassigned patients assume that she would set her;charges at 110 percent of the Medicare-approved fee for a nonparticipating;physician. Assume that her Medicare patient volume is not reduced if she;chooses not to participate nor if she does not accept assignment. (Ignore bad;debt and any other factors not presented here.);Non-Participating;Participating;Assigned;Unassigned;Doctor Charge;\$120;\$120;\$120;Medicare approved;x participating factor;\$100;1.0;\$100;.95;\$100;.95;Medicare allowed;x MAC factor;\$100;1.0;\$95;1.0;\$95;1.10;Max allowable charge;\$100;\$95;\$104.50;Medicare Payment (80%);Patient Payment;\$80;\$20;\$76;\$19;\$83.60;\$20.90;Total allowed;\$100;\$95;\$104.50;1. What will be Dr. Rose?s average;reimbursement per visit if she chooses to be a Medicare-participating;physician? (This is the total from both Medicare and the patients.);2. What will be Dr. Rose?s average;reimbursement per visit if she chooses not to be a Medicare-participating;physician? (This is the total from both Medicare and the patients.);A non-participating physician;provides services to a Medicare patient who has total charges of \$100 (before;Medicare?s limiting charge is applied). The physician does not accept;assignment, charges the maximum allowable, and submits the claim to Medicare.;Assume Medicare?s approved schedule for these services is \$80.;Unassigned;Doctor;charge;\$100;Medicare;approved;x;participating factor;\$80;.95;Medicare;allowed;x;MAC factor;\$76;1.15;Max;allowable charge;87.40;Medicare;payment (80%);Patient;Payment;\$69.92;\$17.48;Total;allowed;\$87.40;3. What is the Medicare portion of the physician;payment (which Medicare sends to the patient)?;4. What is the patient?s portion;of the payment to the physician (net of the reimbursement from Medicare?;The Medical;College of Virginia, located in the urban city of Richmond, Virginia;has a wage index of 1.8579. A student from nearby Virginia Commonwealth;University has just been treated for viral meningitis during a 5-day length of;stay (LOS) (DRG weight: 1.535).;Rate;Table;Hospital Status Labor Non-labor;Urban;Areas 2,800 1,250;Rural Areas 2,000 1,000;5. Use the information in the rate table to calculate the DRG operating;payment for this treatment. Payment = DRG weight x [(Labor amount x wage index);+ Non-labor amount];6. Assuming that the wage index remains the same as in question 13, what;would the DRG operating payment be if the same treatment occurred in the rural;Pulaski County Hospital in Pulaski, VA?;Heads;up from seminar;In a medical record what roles does;data play?;CMS-1500 Form is used by?

Paper#58375 | Written in 18-Jul-2015

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