Saturday
October 25, 2014

Homework Help: reimbursement methodologies

Posted by Barb on Wednesday, May 12, 2010 at 9:49pm.

Could someone check my answers to see if they are correct. Any feedback would be greatly appreciated..


Mrs. Hall was admitted to the hospital for the first time this year on September 15. On September 25, she was transferred to a skilled nursing facility where she stayed until
October 30. She was discharged from the SNF with home health care and a walker.


Table 1
HOSPITAL AND SNF INSURANCE STAY DATA

Insurance Medicare Part A
Total days inpatient stay 10
DRG reimbursement for inpatient stay $13,648
Total hospital charges for inpatient stay $16,000
Total days of SNF stay 35
Total reimbursement charges for the SNF stay $23,000
Home health care approved amount $7,000

KEY: DRG = diagnosis-related group—a system of classifying patient diagnose


1. What reimbursement amount will the hospital receive from Medicare?
A. $12,856 C. $16,000
B. $13,648 D. $23,000

I chose B.

2. What’s the total amount the patient owes for the hospital stay?
A. $0 C. $1,980
B. $912 D. $16,000

I chose A

3. How much does the patient owe for the SNF stay?
A. $0 C. $1,710
B. $99 D. $2,300

I chose A.

4. What’s the total amount the patient owes for home health care?
A. $0 C. $2,500
B. $500 D. $7,000

I chose D.

5. What’s the total amount that Medicare will pay for the home health care, excluding DME
charges?
A. $2,000 C. $7,000
B. $2,500 D. $9,000

I chose C.

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