What is the amount of the cost outlier threshold

Assignment Help Biology
Reference no: EM13883864

PART A

INSTRUCTIONS

Step 1: Click on this link to access the DRG Calculator https://www.tricare.mil/drgrates/

Step 2: Access the DRG calculator for FY2015 Discharges (revised Oct102014) click on the Payment calculator tab at the bottom of the worksheet.

To Determine the Tricare DRG payment, enter the following information in the yellow highlight fields
Billed Charges $250,000.00
Length of Stay 20
DRG 2
Discharge Status 01
# of interns & Residents 20
# of beds 150

Answer the following questions:

1. What is the amount of the cost outlier threshold? (round to reflect dollar amount)
2. What is the total payment amount?

Source: https://www.tricare.mil/tma/default.aspx

PART B

INSTRUCTIONS

You are assigned to perform the yearly office fee schedule update. Using the information provided, calculate the total fee for the E/M codes.

 

CPT

RVU (w)

RVU (pe)

RVU (m)

GPCI (w)

GPCI (pe)

GPCI (m)

CF

Fee

99201

0.48

0.57

0.03

1.009

1.001

1.110

$36.8729


99202

0.93

0.88

0.06

1.009

1.001

1.110

$36.8729


99203

1.42

1.19

0.10

1.009

1.001

1.110

$36.8729


99204

2.43

1.61

0.16

1.009

1.001

1.110

$36.8729


99205

3.17

1.91

0.20

1.009

1.001

1.110

$36.8729


PART C

INSTRUCTIONS

Using the partial chargemaster below, answer the following questions:

1. Patient A was having difficulty breathing. A chest radiograph, 2 views was ordered; identify the CPT Code, Revenue Code, and total charge for the procedure. ­­­­­­­­­­­­­­­­­­­­­­­­­­ _________________________

2. Which department is this chargemaster for? _______________________

3. What is the service description for CPT Code 74241?

Good Medicine Hospital

123 Anywhere Street

Anywhere, NY 12345


Depart: Radiology


Date Printed: 07/25/YYYY

Service Code

Service Description

CPT Code

Revenue Code

Charge

RVU

81500098

Chest X-ray, single view

71010

0320

73.95

0.72

81500099

Chest X-ray, two views

71020

0320

94.65

0.93

81500102

Chest X-ray, special view (bucky)

71035

0320

78.90

0.77

81500104

Upper GI X-ray, with KUB

74241

0324

353.50

2.44







PART D

INSTRUCTIONS

Use the following information to complete a CMS 1500 claim form.

1. Login in and access the Student Online Companion that accompanies the textbook.

2. Open SimClaim and use a blank CMS 1500 claim form and fill in the information.

3. Save the completed CMS 1500 claim form as Project2_PartD and submit the form along with the completed Parts A, B and C above to your instructor.

Date of Service: 6/15/YYYY

Patient ID: 789

Patient Name: Tall, Man

Primary Insurance Name: Aetna

Physician name: Bo Peep

Address: 120 Young Street

Address: PO Box 1121

Address: 456 Old St

City/State: Anywhere, NY

City/State: Medical, PA

City/State: Fall, NY

Zip: 12345

Zip: 12357

Zip: 12345

DOB: 06/03/1955

Plan ID: ZJW55544

EIN: 331234567

Phone: (123) 788-1245

Group #: 650

NPI: 3345678901

Gender: Male

Primary Policyholder: Tall, Man

Phone: (123) 788-6666

Status: Married

Address: 120 Young Street

Place of Service: 11

Employed: Full-Time

City/State: Anywhere, NY

Diagnosis 1: Dyspnea

Zip: 12345

Diagnosis 2: Hypertension

Policyholder DOB: 06/03/1955

Services: 99213 $85.00

Pt Relationship to Insured: Self

Employer Name: Will Solve IT

Work Related? No

Auto Accident? No

Other Accident? No


Reference no: EM13883864

Questions Cloud

What elements should be part of a human experimentation : What elements do you think should be part of a human experimentation or IRB form?
Straight-line to zero over the life of the project : We are evaluating a project that costs $800,000, has an eight-year life, and has no salvage value. Assume that depreciation is straight-line to zero over the life of the project. Sales are projected at 60,000 units per year. Price per unit is $40, va..
Estimate of the cost of steam per ton : Make a rough estimate of the cost of steam per ton, produced from a packaged boiler. 10,000 kg per hour of steam are required at 15 bar. Natural gas will be used as the fuel, calorific value 39 MJ/m3 (roughly 1 MMBtu/1000 scf). Take the boiler eff..
Describe the different types of financial contracts and how : Describe the different types of financial contracts and how they are associated with each type of exposure
What is the amount of the cost outlier threshold : What is the amount of the cost outlier threshold? (round to reflect dollar amount) and What is the total payment amount?
Common stock value : P7-8: Common stock value - constant growth Use the constant-growth model (Gordon growth model) to find the value of each firm shown in the following table. FirmDividend expected next yearDividend growth rateRequired return
Sensitivity analysis on the adipic acid project : Carry out a sensitivity analysis on the adipic acid project described in Example 9.5. Investigate the sensitivity of the 10-year NPV to variation in total fixed capital (-20% to +50%), annual gross profit (-20% to +30%), and project construction s..
What is the statistical interpretation of beta : 1) What is the statistical interpretation of Beta? 2) What is the financial theory interpretation of Beta? 3) What is the statistical interpretation of R2
What is the corporation''s federal tax obligation : What is the corporation's Federal Tax Obligation? Taxable Income: $2,000 Taxable Income: $65,000

Reviews

Write a Review

Biology Questions & Answers

  How genes affect the length of hair

Chupacabras are mammals with hair length that varies from no hair to very long. It is known that two genes affect the length of a chupacabra's hair and that the genes have additive effects.

  Discuss about the gingivitis

Discuss about the Gingivitis - Gingivitis

  Question about serum potassium level

Electrocardiogram results demonstrate a shortened QT interval and an rise in the P-R interval. Laboratory results indicate that his serum potassium level has increased to a value of 6.5 mEq/L.

  Q1 a patient who inherited two defective copies of a gene

q1. a patient who inherited two defective copies of a gene essential by white blood cells suffered from a severe immune

  Tissue culture technique

Does anybody know anything tissue culture technique? I want to know what gives a positive result and what gives a negative result?

  What intracellular second messenger is primary regualator

What intracellular messenger is primary regulator of adaptation of photoreceptors?What Intracellular second messenger is primary regualator.

  What types damages or diseases

"The genetic material ultimately unravels, deteriorates, and the cell dies. This causes cells to die over time, or "age" so they cannot infinitely keep duplicating." What types damages or diseases do we experience as a result of the unraveling and..

  Q1 in a paragraph of your own words or a sequence of

q1. in a paragraph of your own words or a sequence of illustrations using a 21st century tool identify two potential

  I your opinion describe the merits and demerits of

in your opinion discuss the advantages and disadvantages of computer-generated medical records. how might patient

  Isotope of pgisphorous

The most abundant from of phosphorous has 15 protos, 16 neutrons and 15 electrons. Determine which of the following is an isotope of pgisphorous?

  What''s the possible use of enzyme''s electrostatic potential

What's the possible use of enzyme's electrostatic potential.

  Describe how christian anfinsen''s ribonuclease

define in your own words how Christian Anfinsen's ribonuclease renaturation experiments showed that amino acid sequence determines tertiary structure.

Free Assignment Quote

Assured A++ Grade

Get guaranteed satisfaction & time on delivery in every assignment order you paid with us! We ensure premium quality solution document along with free turntin report!

All rights reserved! Copyrights ©2019-2020 ExpertsMind IT Educational Pvt Ltd