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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