Reference no: EM13987620

CALCULATING APC PAYMENT RATES - Problem 1

APC	Relative Weight	Unadjusted Payment Rate	Wage Index for NJ	National Unadjusted Coinsurance	Minimum Unadjusted Coinsurance
005	5.41	262.31	1.1186	119.75	53.66

NATIONAL CONVERSION FACTOR: $ 48.487      

The Unadjusted Payment rate is calculated by multiplying the Relative Weight x the National Conversion Factor:

___________   X    $__________  =  $ __________  (Should be same as above)

STEP 1:  Adjusting for your area wage index.  Wage index applies to 60% of the hospitals OP costs, but not to the remaining 40%.  Round all answers to 2 decimal places (5^th digit below 5 do not round, 5 or above round up)

$ _________ x  0.60 =  $ __________

Multiply the sum by the wage index.

$ ___________   X    __________  =  $ __________

Add the remaining 40%.

$ ___________   X   0.40  =  $ __________

Add the two sums together.

$ __________ + __________ =  $ __________

STEP 2:  Subtract any applicable deductible.  (assume the patient still owes $50.00 toward annual deductible)

$ __________ - $50.00 = $ __________ (THIS IS YOUR ADJUSTED APC AMOUNT)

STEP 3:  Calculate the Medicare payment percentage.

1. Subtract the national unadjusted coinsurance from the unadjusted payment rate.

$ __________ -  $__________ = $ __________

2. Divide the answer by the unadjusted payment rate.

$ __________ / $ __________ = __________ (calculator should be set at max decimal places-DO NOT ROUND)

This is the percentage of the APC amount that Medicare will pay.

STEP 4:  Multiply the adjusted APC payment by the Medicare payment percentage.  (Multiply the answer in Step 2 by the answer in Step 3)

$ __________ x  __________ = $ __________

STEP 5:  Beneficiary Coinsurance Amount:  Subtract the Medicare payment from the adjusted APC rate (subtract the answer from Step 4 from the answer in Step 2)

$ __________ - $ __________ = $ __________

STEP 6:  Determine your final payment.  Add the Medicare Payment + coinsurance + deductible

$ __________  +  $ __________ + $ __________  =  $ __________

CALCULATING APC PAYMENT RATES - Problem 2

APC	Relative Weight	Unadjusted Payment Rate	Wage Index for NJ	National Unadjusted Coinsurance	Minimum Unadjusted Coinsurance
010	.55	26.67	1.1186	9.86	5.46

NATIONAL CONVERSION FACTOR: $ 48.487      

The Unadjusted Payment rate is calculated by multiplying the Relative Weight x the National Conversion Factor:

___________   X    $__________  =  $ __________  Should be the same as in the above grid

STEP 1:  Adjusting for your area wage index.  Wage index applies to 60% of the hospitals OP costs, but not to the remaining 40%. Round all answers to 2 decimal places (5^th digit below 5 do not round, 5 or above round up)

$ _________ x  0.60 =  $ __________

Multiply the sum by the wage index.

$ ___________   X    __________  =  $ __________

Add the remaining 40%.

$ ___________   X   0.40  =  $ __________

Add the two sums together.

$ __________ + __________ =  $ __________

STEP 2:  Subtract any applicable deductible.  (assume the patient still owes $10.00 toward annual deductible)

$ __________ - $10.00 = $ __________ (THIS IS YOUR ADJUSTED APC AMOUNT)

STEP 3:  Calculate the Medicare payment percentage.

1. Subtract the national unadjusted coinsurance from the unadjusted payment rate.

$ __________ -  $__________ = $ __________

2. Divide the answer by the unadjusted payment rate.

$ __________ / $ __________ = __________ (calculator should be set at maximum decimal places)

This is the percentage of the APC amount that Medicare will pay.

STEP 4:  Multiply the adjusted APC payment by the Medicare payment percentage.  (Multiply the answer in Step 2 by the answer in Step 3)

$ __________ x  __________ = $ __________

STEP 5:  Beneficiary Coinsurance Amount:  Subtract the Medicare payment from the adjusted APC rate (subtract the answer from Step 4 from the answer in Step 2)

$ __________ - $ __________ = $ __________

STEP 6:  Determine your final payment.  Add the Medicare Payment + coinsurance + deductible

$ __________  +  $ __________ + $ __________  =  $ __________.