Question: Your hospital has just opened a new cardiac surgery program and you have been asked to calculate the net revenue per open heart surgery. Here

Your hospital has just opened a new cardiac surgery program and you have been asked tocalculate the net revenue per open heart surgery. Here is the relevant data: Cases: Medicare 125: Insurance 50 Medi-Cal 25 Total Charges per Case is $75,000 The length of stay for case is 7 days The Medicare DRG payment for an open-heart surgery (simplified for this problem) is $55,000.20% of this amount is paid by the patients as their co-insurance and the hospital collects 80% of that amount. Your hospital is subject to a cap on Medi-Cal inpatient reimbursement (MARL) which is $7,000 per case but they generally pay $1,500 per day. Your insurance contracts pay off of a fee scheduled for this case at $25,000 butyour contracts also have a stop loss provision that if charges are over $65,000, theamount over $65,000 is paid at 90% of charges. What is the net reimbursement for cardiac case?Attach your spreadsheet.

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