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December 19, 2014

Homework Help: Reimbursement Methodologies

Posted by Jessica on Wednesday, January 5, 2011 at 1:43pm.

You're reviewing reimbursement for a Medicare surgical craniotomy case. The case falls into DRG1, which has a relative weight of 3.0970 and a geometric mean length of stay of 6.3. The hospital's current standard reimbursement rate is $1500. Calculate the DRG reimbursement for this case.

ok i looked up how to calculate DRG reimbursement and it said:
1. Find the group code that applies to the specific medical treatment provided using the DRG coding table.
2. Match the group code with the appropriate weight on the weight table.
3. Multiply the DRG weight by the Standard Base Rate the hospital charges for any HMO network member. The result will be the appropriate amount of the claim.

So 3.0970x1500= 4645.5. so this is my answer? im confused.

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