HospitalInformation
HOPPS/ASC: Use the information found in figures 1–5 below to completethe OPPS payment calculations in table 1 and the ASC PPS payment calculationsin table 2. Determine the OPPS and ASC reimbursement rates for acataract procedure. Answer the discussionquestion.
Click and download the exercise and the answer sheet. Submit answer sheet via blacboard by or before 11/9/2015
Figure 1: HospitalInformation
| Bedsize: | Teachingstatus: | Wage index:.9971 | |
| 300 beds | Non-teaching | ||
| Cost to Charge Ratios(CCRs) | |||
| RC250 | Pharmacy,general | 0.408344 | |
| RC270 | Supplies,general | 0.796788 | |
| RC271 | Nonsterilesupply | 0.796788 | |
| RC272 | Sterilesupply | 0.796788 | |
| RC276 | Intraocularlens | 0.796788 |
| RC301 | Chemistry | 0.291546 |
| RC312 | Pathology,surgical | 0.291546 |
| RC360 | Operatingroom | 0.404314 |
| RC370 | Anesthesia | 0.321246 |
| RC710 | Recoveryroom | 0.404314 |
| RC730 | EKG | 0.38251 |
| RC920 | Diagnosticservices | 0.88447 |
Figure 2: Claim Information Hospital OutpatientDepartment
| Admitdate | 2/20/2015 | Dischargedate | 2/20/2015 |
| Sex:F | Age:70 | LOS: 1day | |
| Admitdiagnosis | 366.9 | Cataract,unspecified | |
| Principaldiagnosis: | 366.10 | Senile cataract,unspecified | |
| Principalprocedure: | 66984 | Cataract extraction with IOLinsertion | |
| ChargeDetail | |||
| RevenueCode | CPT/HCPCSCode | CodeDescription | Charge |
| 250 | $475.25 | ||
| 270 | $380.25 | ||
| 271 | $1178.18 | ||
| 272 | $1297.07 | ||
| 276 | $551.00 | ||
| 301 | 36415 | Routine venipuncture | $10.00 |
| 301 | 82565 | Assay ofcreatinine | $33.75 |
| 301 | 84132 | Assay ofserum potassium | $33.75 |
| 301 | 85014 | Hematocrit | $34.75 |
| 312 | 88304 | Tissue examby pathologist | $83.50 |
| 360 | 66984 | Cataractextraction w/IOL | $801.33 |
| 370 | $574.00 | ||
| 710 | $341.00 | ||
| 730 | 93005 | Electrocardiogram, tracing | $124.50 |
| 920 | 90772 | Ther/proph/diaginj, sc/im | $75.50 |
| TOTALCharges | $5,693.83 | ||
| Medicare beneficiary copaymentamount: | $531.88 | ||
Figure 3: Claim Information Ambulatory SurgeryCenter
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| CPT Code:66984 | Cataract extractionwith IOL | Charges: $2,500.00 |
| Medicare beneficiary copaymentamount: | $192.76 | |
Figure 4: Fee Schedule Information (CY 2012; to get current year seewww.cms.gov)
| RevenueCode | CPT/HCPCS | FeeSchedule Amt | StatusIndicator |
| 301 | 36415 | $3.00 | A |
| 301 | 82565 | $7.26 | A |
| 301 | 84132 | $6.51 | A |
| 301 | 85014 | $3.35 | A |
Figure 5: APC Information (CY 2012; to get current year seewww.cms.gov)
| RevenueCode | CPTCode | APC | Relative Weight | StatusIndicator |
| 312 | 88304 | 0343 | 0.5262 | X |
| 360 | 66984 | 0246 | 23.8786 | T |
| 730 | 93005 | 0099 | 0.3823 | S |
| 920 | 90772 | 0436 | 1.8104 | S |
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