Determine the loss per patient

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Reference no: EM133339300

Case: 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

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 departments
0.5 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.

Reference no: EM133339300

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