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HI215 Final Project Instructions and Guidance

HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

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Page 1: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

HI215 Final Project

Instructions and Guidance

Page 2: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project: Scenario

• The executive finance team at Anywhere Hospital is reviewing charge levels for various surgical units.

• The team leader has requested a CDM management report from the CDM coordinator (You). She would like the report to include the following: 1. Medicare reimbursement, cost, and profit for procedures

performed during first quarter 20xx (current year).

2. Additionally, she would like third-party payer average reimbursement, cost, and profit for the same time period.

Page 3: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project

This is a portion of your spreadsheet in which you will provide all of the calculations for the columns in red. Definitions include the following: MCR Reimbursement: Medicare Reimbursement; TPP Reimbursement: Third Party Payer and then cost, profit, and overall profit based on volume.

Page 4: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project: Formulas and Instructions• Complete the Excel spreadsheet and provide

your analysis. 1. To obtain the MCR Reimbursement (Medicare):

Locate current Medicare rate for each CPT code on the most current OPPS Addendum B. Copy the link below into your Web browser or view in Slide Show:

Visit http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/HospitalOutpatientPPS/Addendum-A-and-Addendum-B-Updates.html to find and download Addendum B (center of page)

2. Transfer the rate figure from Column “F” to the correct row on your spreadsheet in Column “I”

Page 5: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for
Page 6: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for
Page 7: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Addendum B CMS TableThe CMS Table will open up after you agree to the terms. Take the payment rate from Column “F” and transfer the dollar amount for the specified HCPCS Code. Be very carefulin transferring the right rates to the right codes on your spreadsheet.

Page 8: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final ProjectMCR Rates from Table go in

Column I

Utilize =F2*.62 for TPP Reimbursement for Column J

(see instruction 2)

Page 9: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project: Instructions

1. “TPP Reimbursement” (Third Party Payer): Calculate the TPP Reimbursement using the following formula in Excel: (=F2*.62) -average reimbursement rate for TPP Column F (charge multiplied by .62)

Insert the calculated figure in Column J

2. MCR Cost = Charge * RCC. – Use the RCC provided in the scenario based on the line item

revenue code• 360 is 0.4043• 320 is 0.5267

3. TPP Cost = Charge * RCC. Note: there is no difference between MCR cost and TPP cost.

Page 10: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project

MCR Cost and TPP Cost = Charge * RCCUse the RCC provided in the scenario based on the line item Rev Code D360 is 0.4043 (=F( ) * 0.4043) or 320 is 0.5267 (=F2 * 0.5267)Insert the calculated figure in both Column K and Column L; they will be the same.

Page 11: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project

• This is a partially completed table showing the MCR Cost and TPP Cost. Now you will calculate profit.

Page 12: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project

1. MCR Profit = MCR Reimbursement – MCR Cost

2. TPP Profit = TPP Reimbursement – TPP Cost3. MCR Overall Profit: Multiply profit figures

times volumes provided.4. TPP Overall Profit: Multiply profit figures

times volumes provided See following example for formulas

Page 13: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project Instructions

MCR Profit = MCR Reimbursement – MCR Cost: Excel Formula (=I2-K2) for Column MTPP Profit = TPP Reimbursement – TPP Cost: (=J2-L2) for Column N

Page 14: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project Instructions

To calculate Overall MCR Profit, use Formula (=G2*M2) for Column “O”

To calculate Overall TPP Profit, use Formula (=H2*N2) for Column “P”

Page 15: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project

• This is the completed spreadsheet for the first two rows of your Assignment. Review carefully.

Page 16: HI215 Final Project Instructions and Guidance. Final Project: Scenario The executive finance team at Anywhere Hospital is reviewing charge levels for

Final Project: AnalysisNow that you have completed your spreadsheet, answer the following questions in a separate Word Document. Support your answers.

• Are either of the payers profitable for Anytime Hospital in this outpatient surgical area?

• What are the most profitable Medicare procedures? Least profitable?

• What are the most profitable Third Party procedures? Least profitable?

• What would you suggest to the Team Leader for the CDM Management?