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Question 1: The CFO at General Hospital noticed that the losses for Medicare CHF patients were becoming larger each year. In order to understand why this is occurring, he assigned a data analyst to review the issue. The analyst requested a file including the following billing information for each case in grouping to one of the CHF MS-DRGs (291, 292, 293):
Data Dictionary
Data Element Definition Patient Patient ID LOS Length of Stay Age Patient Age Category Sex Patient Gender AmtReim Amount Paid by Medicare TotAccomChg Total Accommodation Charges TotDeptChg Total Ancillary/Departmental Charges NumDxCodes Number of Diagnosis Codes on Claim admsrc Admission Source dischdest Discharge Destination drgcode MS-DRG Code
Data Element
Definition
Patient
Patient ID
LOS
Length of Stay
Age
Patient Age Category
Sex
Patient Gender
AmtReim
Amount Paid by Medicare
TotAccomChg
Total Accommodation Charges
TotDeptChg
Total Ancillary/Departmental Charges
NumDxCodes
Number of Diagnosis Codes on Claim
admsrc
Admission Source
dischdest
Discharge Destination
drgcode
MS-DRG Code
For this exercise, you must:(1) Use the data dictionary to identify the fields that you need to use in order to determine profit (loss) for each patient.(2) Sort the database by DRG(3) Determine the loss per patient/case:(a) Use the spreadsheet and calculate costs using the Cost:Charge model:Assume that the cost to charge ratio (CCR) for General Hospital is:0.3 for ancillary departments0.5 for accommodation departments.Hint: you need to apply the CCR to determine what the costs are.(b) Subtract the cost from the amount reimbursed to determine the profit/loss(4) Creat a new spreadsheet that presents the CFO with the overall loss per DRG.Submit your work in an Excel spreadsheet.
Attachment:- CHF Data.rar
i need to find the CCR ratio and subtract from reimbursement.
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