Case Assignment

Using the information in the Module $4$ overview and required readings, as well as some additional

research in peer$-$reviewed sources, complete your Case assignment by answering the questions in the

following two$-$part assignment. Please show all formulas and calculations of your work in your paper.

Part I $-$ Paying for Hospital Services $-$ Overview

Mrs$.$ Jones is a $74-$year$-$old woman who is currently hospitalized for an ischemic stroke. She's at a large

urban Philadelphia hospital, and in the past few days, she's incurred $$189,000$ in Medicare$-$approved

charges for her care. Using the information provided in this Module, as well as the Hospital Payments

Example $($found in the Course's table of contents link under "Presentations"$),$ use the DRG table below to

answer the following questions. Be sure to include all formulas and calculations used in your paper.

Part I $-$ Assignment

In approximately three pages, answer the following questions related to Mrs$.$ Jones' ischemic stroke.

Show all formulas and calculations of your work.

What is the operating payment to be paid to the hospital?

What is the capital payment to be paid to the hospital?

Will the hospital be eligible for the Medicare outlier payment for this patient?

What is the total payment due to the hospital?

Part II $-$ Paying for Physician Services $-$ Overview

Mr$.$ Thompson is an $83-$year$-$old Medicare beneficiary. He is under the care of Dr$.$ Heintz. Assume the

following values for services provided by Dr$.$ Heintz:

Part II $-$ Assignment

In approximately three pages, answer the following questions. Show all formulas and calculations of your

work.

How much will Medicare pay Dr$.$ Heintz if he is a Medicare participating physician? How much out$-$of$-$

pocket payment will Mr$.$ Thompson be responsible for?

How much will Medicare pay Dr$.$ Heintz if he is a Medicare non$-$participating physician who elects

assignment? How much out$-$of$-$pocket payment will Mr$.$ Thompson be responsible for?

How much will Medicare pay Dr$.$ Heintz if he is a Medicare non$-$participating physician who does not

elect assignment? How much out$-$of$-$pocket payment will Mr$.$ Thompson be responsible for?