“PAYING FOR HOSPITAL AND PHYCIAN SERVICES”
Part I SLP Paying for Hospital Services
Discuss in about 2 pages the advantage and disadvantage of the following hospital payment systems on cost containment and provider behavior:
• Per diem
• The DRG-based system payment (i.e., Medicare’s Inpatient Prospective Payment System)
Part II SLP Paying for Physician Services
Answer the following questions in about 2 pages:
• Discuss the difference in Medicare payment methods for outpatient services and physician services.
• Discuss the difference between bundled payments and global payments.
Part III Case Scenario Paying for Hospital Services
Mr. Scott is a 69 year old hospitalized for a Permanent Cardiac Pacemaker procedure. Hillcrest Hospital is a large urban hospital in Cleveland that incurred $275,000 in Medicare-approved charges for treating Mr. Scott. Use the “M4 Hospital Payments Example” (see attached browse) to answer the following questions. Include all formulas and calculations in your paper.
DRG DESCRIPTION CASE WEIGHT
115 Permanent Cardiac Pacemaker 3.5513
302 Kidney Transplant 4.1370
441 Hand Procedure/Surgery 0.8785
Answer in about 3 pages the following questions for Kidney Transplant ONLY:
• 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?
• What is the total payment to the hospital?
Part IV Case Scenario Paying for Physician Services
Mr. Roberts is a 66 year old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:
CATEGORIES RVU GEOGRAPHIC COST INDEX PRODUCT
Work 24.35 1.092 29.98
Practice Expense 37.08 1.743 75.04
Malpractice 15.69 0.543 5.60
Conversion Factor = 64.43
Answer in about 3 pages the following questions:
• How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare participating physician? How much out-of-pocket payment will Mr. Roberts be responsible for?
• How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare NON participating physician who elects assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
• How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare NON participating physician who does NOT elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
• Please utilize the attached Rubric Grading
• Paper should have 0% plagiarism
• Paper should NOT have more than 5% Similarity Index upon submission to TURNITIN