MEDICARE FUNDING AND REIMBURSEMENT

Medicare Funding and Reimbursement



Medicare Funding and Reimbursement

Part A

What is the operating payment to be paid to the hospital?

The operating payment paid to the hospital will be $47,500. This calculated by multiplying the bill charged on Mrs. Anderson with the operating cost to the charge ratio. This operating to the charge ratio applied to the covered charges for a case to determine whether the costs of the case exceed the fixed-loss outlier threshold. However, this includes total operating expenses and effective gross income. The sustainable growth rate calculates depending on the physician payments that based on the formula comparing the target expenditure and actual expenditures (Troup, 2005).

What is the capital cost payment to be paid to the hospital?

The capital cost payment is $5,000 which calculated by multiplying Billed Charges to the Capital Cost to Charge Ratio. This capital cost to charge ratio includes all those payment made on capital in order to determined the capital cost exceed the fixed outlier.

What Cost Outlier payments will the hospital be eligible for?

To determine the amount cost outlier, firstly determine if Total Costs are Greater than Combined Threshold.

Total Costs are Greater than Combined Threshold = (if (operating costs+ capital costs) > (operating threshold + capital threshold))

If the following equation comes out to be true then determine operating and capital outlier payment.

Operating Outlier Payment = (Operating Costs - Operating Outlier Threshold) x Marginal Cost Factor $1,656.58

Capital Outlier Payment = (Capital Costs - Capital Outlier Threshold) x Marginal Cost Factor

$677.47

Note this; if capital outlier comes put to be negative then it assumed the amount to be zero.

The total cost outlier payment will be $ $2,334.05.

What is the total payment to the hospital?

Total payment to the hospital include the federal operating payment, federal capital payment, operating and capital cost, operating and capital outlier which equals to

$24,407.58+ $1,923.47+ $47,500+ $5,000+ $54,929.28+$5,153.16= $138913.49

What is the payment for the skilled nursing facility?

Skilled nursing facility is important as she look after the patient, meets their needs and gives them a satisfactory quality care. However, this SNF possesses a certain amount of charges which Mrs. Mrs. Anderson has to pay.

One should plan for all these services if one needs for it, if one is leaving for home or one is thinking to leave SNF for home one would need help in shopping, dressing, bathing transportation and grocery. Before approving the SNF, checklist should be looked to see the particulars of the nurse. Mrs. Anderson stays at a skilled nursing facility for 30 days which is equal to 30*128 that is equal to $ 3840 (128 per day to the SNF). If the person are to received Medicare services at the same time with the help of a skilled nurse one may have a lasting appeal. (Verducci, 2000).

Part B

The clinical care uses prospective payment systems for hospital and nursing care. This payment system deals with the health care institutions who receive an amount for providing care to patients in episode, inspirit of the genuine amount of care ...