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ABC A % 2 87 Word O duelill Mac 3 hall A - In-class assignment Inpatient Reimbursement-- Questions (9) - ...| gigg HU wilali bis . . . Ap " Aa A A v 12 v Times New... mail M clewbel ! sjo blair blais VALA x x2 ab U I B Application Exercises 1. IPF PPS: Use the information found in figures 1-2 (below) and tables [6.6 to 6.11] from the textbook to complete table 1 in order to determine the IPFPPS 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: $651.76 Figure 2: Claim Information Admit Date: January 1, 2018 |Discharge Date: January 15, 2018 LOS: 14 days Patient Age: 62 6 Lis jo Principal Diagnosis: 295.34 Paraphrenic schizophrenia, chronic with acute exacerbation Secondary Diagnosis: 301.6 Dependent personality disorder Secondary Diagnosis: 250.02 |Uncontrolled diabetes mellitus MS-DRG: 885 Psychoses LECT treatments: 90870 3 units $280.60 per unit IPFPPS Payment Determination Steps (Use these steps to complete the tables below.) Step One: Wage index adjust the labor portion of the per-diem rate Step Two: Apply COLA to the non-labor portion of the per-diem rate if applicable Step Three: Add results of step one and step two to determine the wage adjusted per-diem rate Step Four: Step Five: Apply the patient-level and facility-level adjustments Multiply the PPS adjustment factor by the wage adjusted per-diem rate to calculate the adjusted per-diem rate Step Six: Step Seven: Identify whether the facility has a qualifying ED Multiply the adjusted per-diem rate by the LOS adjustment factor for each day of the stay to calculate the per-diem payment amount Step Eight: Sum the per-diem payment amounts calculated for each day of stay Step Nine: Calculate the adjusted ECT amount if applicable Step Ten: Sum payments to calculate IPFPPS reimbursement Table 1 100% + LX alats 1177 2009 P X O W AABC A % 2 8 Word O duelill Mac 3 hall A - In-class assignment Inpatient Reimbursement-- Questions (9) - ...| gigg HU wilali bis . . . A " Aa A A v 12 v Times New.. mail M clewbel ! Mo ! sjo blair blais MIE EEEE VALA x x2 ab U I B Table 1 Step Methodology Total One (per-diem rate * .75788 * WI Two If COLA then (per-diem rate * .24212 * COLA) If non-COLA then (per-diem rate * .24212) Three Sum results of step 1 and step 2 6 Lis jo Four Use mini-worksheet A (see below) Five Multiply result of step 3 times result of step 4 Six 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 Seven Use mini-worksheet B (see below) Eight Sum of day rates calculated in step 7 Nine If COLA then ((ECT pymt rate * .75889 * WI)+(ECT pymt rate * .24111 * COLA)) * units of service If non-COLA then ((ECT pymt rate * .75889 * WI) + (ECT Rumt rate * .24111)) * units of service Ten Sum results of step 8 and 9 Mini Worksheet A 100% + LX alats 1177 2009 P X O W 4 AABC A 1% 2 8 Word O duelill Mac 3 hall A - In-class assignment Inpatient Reimbursement-- Questions (9) - ...| gigg EQUA wilali bis . . . 21 > IT IVEVEVE Ap " Aa A A v 12 v Times New... mail M clewbel ! sjo blair blais MIE EEEE VALA x x2 ab U I B Mini Worksheet A A. Enter adjustment factor if rural location: B. Enter adjustment factor if teaching facility: Enter PPS C. Enter adjustment factor for DRG: adjustment Step Four D. Enter adjustment factor for comorbidity: factor in E. Enter adjustment factor for age: Table I Multiply applicable adjustment factors together row four. to determine PPS adjustment factor: Mini Worksheet B Day Adjustment Adj. Factor * adjusted per-diem rate Facto (step 5) Day one 6 Lis jo Day two Day three Day four Day five Step Day six Seven Day seven Day eight Day nine Day ten Day eleven Day twelve Day thirteen Day fourteen 2. IPPS: High cost devices are used in many inpatient surgery cases. The Safe-Cross@, radio frequency total occlusion crossing system, is such a device. 100% + EO LX alals 1177 5 is 2 bell 2009 P X O W 4 A