Use the information found in Figures 1 and 2 (below) and Tables 6.4 through 6.9 in the textbook to complete the table in order to determine the IPFPPS reimbursement for this encounter. Please use the sample spreadsheet with example computations provided in Lesson 7 commentary (under Inpatient Psychiatric Facility Prospective Payment System: IPFPPS Reimbursement Example) and submit the spreadsheet; using the example spreadsheet will help your work --- you do not have to reinvent the wheel!

Figure 1: Facility Information
Bed size: 350 beds	Location: Any Village, Any State
Classification: Rural	Wage Index: 0.9468
Full Service ED: Yes	Per diem unadjusted rate (Year 2015): $728.31

Figure 2: Claim Information
Admit Date: February 2, 2015	Discharge Date: February 21, 2015		LOS: 18 days
Patient Age: 74
Principal Diagnosis:	Degenerative nervous system disorders w MCC
Secondary Diagnosis:	Chronic obstructive pulmonary disease
MS-DRG: 056	Degenerative nervous system disorders w MCC
ECT (Electroconvulsive Therapy) treatments: 90870	4 units	$313.55 per unit (Year 2015)

Part A

Based on the above documentation, what MS-DRG code will you assign to this case? (Hint: Review the IPFPPS discussion in the textbook chapter 6 including Table 6.6).

Compute the IPFPPS reimbursement amount for the above scenario.

Details

Refer to Commentary 3 under Lesson 7 for computing IPFPPS.

Download the Excel spreadsheet in the above commentary.

Follow the step-by-step process outlined in the above commentary and the spreadsheet.

Modify the Excel spreadsheet to include the data mentioned in this problem, and compute the reimbursement amount in the Excel spreadsheet.

Part B

Please fill the following tables for the inpatient prospective payment systems:

	IPPS Payment Process	IPFPPS Payment Process
Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)
Patient data that must be presented with the claim
Facility level adjustments
Patient level adjustments
High cost outlier payment process, if applicable (write a few sentences for the process)
Other adjustments, if any

Part C

Apply the process to compute the ESRDPPS for the following patient:

John, a 45 year old male Medicare beneficiary, is 187.96 cm. (1.8796 m.) in height and weighs 95 kg. John was diagnosed with ESRD in early 2013 and has been on HD since May 2015. He has chronic hemolytic anemia with sickle cell anemia.

Details

See the commentary on computing ESRDPPS and use the example spreadsheet in lesson 9.

Assume a wage index of 0.9804 and a base rate of $239.78.

Compute ESRD payment amount for John for the month of May for a duration of 28 days.

Part D

Please fill the following tables for the ambulatory care prospective payment systems:

	HOPPS Payment Process	ASCPPS Payment Process	ESRD Payment Process	HSPS Payment Process
Type of code used to determine the payment and the process by which the code is arrived at (write a few sentences for the process)
Patient data that must be presented with the claim
Facility level adjustments
Patient level adjustments
Outlier payment processes, if applicable (write a few sentences for the process)
Other adjustments, if any