Application Exercises

IPF PPS: Use the information found in figures 1 and 2 (below), Tables 6.5-6.9 and figure 6.7 from the textbook to complete table 1 and worksheet A&B in order to determine the IPF PPS reimbursement for this encounter.

Figure 1: Facility Information
Bed size: 350 beds	Location: Columbus, Ohio
Classification: Rural	Wage Index: .9806
Full Service ED: Yes	Per-diem unadjusted rate (RY 2015): $728.31

Figure 2: Claim Information
Admit Date: January 1, 2015	Discharge Date: January 15, 2015		LOS: 14 days
Patient Age: 62
Principal Diagnosis: 295.34*	Paraphrenic schizophrenia, chronic with acute exacerbation
Secondary Diagnosis: 301.6	Dependent personality disorder
Secondary Diagnosis: 250.02	Type II diabetes mellitus uncontrolled
MS-DRG: 885	Psychoses
ECT treatments: 90870	3 units	$315.55 per unit (RY 2015)

*Diagnosis not converted to ICD-10-CM because service dates for this claim are prior to implementation of ICD-10-CM/PCS

IPFPPS Payment Determination Steps (Use figure 6.7 from the textbook.)

Table 1
Step	Methodology	Total
A	Wage Index:	$
B	COLA:	$
C	Base rate adjusted for geographic factors (Add steps A + B)	$
D	Apply facility and patient adjustments - Use Worksheet A
E	Base rate adjusted for facility and patient adjustments (Multiply steps C*D)	$
F	If full service ED then choose higher Day 1 adjustment in step 7 If not full service ED then choose lower Day 1 adjustment in step 7
G	Adjust for daily costs - Use Worksheet B
H	Enter the results from Worksheet B	$
I	Calculate ECT payment Remember to WI ECT payment	$
J	Add the total from step H to the total ECT payment (step I) to calculate total IPF PPS Payment	$

Worksheet A
Table 1 Step D	A. Enter adjustment factor if rural location:		Enter PPS adjustment factor in Table 1 Step D.
	B. Enter adjustment factor if teaching facility:
	C. Enter adjustment factor for DRG:
	D. Enter adjustment factor for comorbidity:
	E. Enter adjustment factor for age:
	Multiply applicable adjustment factors together to determine PPS adjustment factor:

Worksheet B
Table 1 Steps G&H	Day	Adjustment Factor (Step D)	Base rate adjusted for facility and patient characteristics (Step C)	Multiply Adjustment Factor * Adjusted Base Rate
	Day one
	Day two
	Day three
	Day four
	Day five
	Day six
	Day seven
	Day eight
	Day nine
	Day ten
	Day eleven
	Day twelve
	Day thirteen
	Day fourteen
TOTAL				$

Length-of-stay adjustment se Day of StayVariable Per Table 6.5. Day I Table 6.6. Psychia Day 2 1.12 payme DRG Title Day 3 Day 4 Day 5 Day 6 Day 7 1.05 system disorders w M 1.04 system disorders wa Nontraumatic stupo coma w MCC Day 8 1.01 Nontraumatic stupo coma w/o MCC Day 9 Day 10 mine O.R. procedure w diagnoses of ment cost tical dict ent ent le). PS Acute adjustment reaction & psycho dysfunction Day 12 0.99 Depressive neuro Day 13 0.99 Neuroses except depressive Day 15 Day 16 Day 17 y 18 Disorders of pe impulse control 0.98 Organic disturb mental retardat 0.97 0.97 0.96 0.95 0.95 0.95 Psychoses diagnoses 21 0.92 Length-of-stay adjustment se Day of StayVariable Per Table 6.5. Day I Table 6.6. Psychia Day 2 1.12 payme DRG Title Day 3 Day 4 Day 5 Day 6 Day 7 1.05 system disorders w M 1.04 system disorders wa Nontraumatic stupo coma w MCC Day 8 1.01 Nontraumatic stupo coma w/o MCC Day 9 Day 10 mine O.R. procedure w diagnoses of ment cost tical dict ent ent le). PS Acute adjustment reaction & psycho dysfunction Day 12 0.99 Depressive neuro Day 13 0.99 Neuroses except depressive Day 15 Day 16 Day 17 y 18 Disorders of pe impulse control 0.98 Organic disturb mental retardat 0.97 0.97 0.96 0.95 0.95 0.95 Psychoses diagnoses 21 0.92