For Pancreas Transplant, DRG code is 010. For DRG 010, Medicare pays fixed amount of $21,313.50. Outlier threshold for Medicare is $25,800. (a) John admitted hospital A for pancreas transplant. The charges for John’s treatment was 128,000. Cost to charge ratio for Hospital A was 0.10. How much payment hospital A would get from Medicare?

For Pancreas Transplant, DRG code is 010. For DRG 010, Medicare pays fixed amount of $21,313.50. Outlier threshold for Medicare is $25,800. (a) John admitted hospital A for pancreas transplant. The charges for John’s treatment was 128,000. Cost to charge ratio for Hospital A was 0.10. How much payment hospital A would get from Medicare?

EBK HEALTH ECONOMICS AND POLICY

7th Edition

ISBN:9781337668279

Author:Henderson

Publisher:Henderson

Chapter12A: Appendix 12a Changing Demographics: The Aging Of America

Section: Chapter Questions

Problem 4QAP

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For Pancreas Transplant, DRG code is 010. For DRG 010, Medicare pays fixed amount of $21,313.50. Outlier threshold for Medicare is $25,800. (a) John admitted hospital A for pancreas transplant. The charges for John’s treatment was 128,000. Cost to charge ratio for Hospital A was 0.10. How much payment hospital A would get from Medicare? (b) Bryan admitted hospital B for pancreas transplant. The charges for Bryan’s treatment was same as John, $128,000, but cost to charge ratio for Hospital B was 0.25. How much payment hospital B would get from Medicare?
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