reimbursement methodologies

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

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
A. $2,000 C. $7,000
B. $2,500 D. $9,000

I chose C.

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  1. You only got #1 correct. I just took this test about 2 weeks ago and have the answers in front of me. i will walk you through it. in your book go to page 249....

    #2. if the stay was for 10 days then she automatically owes $912 (annual deductible) so the answer is B. $912

    #3. she was in the SNF which is free for the first 20 days. so, she pays $114 per day for the last 15 days. 114x15=1710. so the answer is C. $1710

    #4. she pays 20% of her DME which is $2,500. 2,500x .20=500... so that would be B. $500

    #5 the total amount medicare will pay for home health care is the amount for the DME which is $2,000 (patient pays $500) plus the $7,000 approved amount which equals.... D. $9,000

    hopefully this makes sense to you as it took me a while to figure it out. good luck :)

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  2. 1-A, 2-B, 3-C, 4-A, 5-C

    I took the pennfoster test and received a 100%

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  3. Robles,

    I am working on this exam right now. I am having problems with the question - What reimbursement amount will the hospital recive from Medicare? You say it is A. $12,856. What are your calculations? I just can't see how you came up with that amount.

    If Robles or someone else could show me how to get $12,856 I would really appreciate it.

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  5. Hi guys.I am working with this exam too right now and I don't understand how you guys can came up with...
    1. A or B? What calculate did u guys used?
    4. $2500*20%. How that $2500 from?
    5. $7000+$2000. How that $2000 from?
    Thanks a lot for the feedback.

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