How does the presence of a CC/MCC code impact the reimbursement for an admission
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MS-DRG Calculations (Level 4—Analyzing)
For this exercise, use the file titled AB202019_Ch05_Exercises.xlsx, tabs MS-DRG Calculation Example and MS-DRG Calculations. This assignment consists of 10 inpatient acute-care admissions; 5 for Community Hospital and 5 for Memorial Hospital. Calculate the MS-DRG reimbursement rate for each admission (there are examples on the 1st tab of the file). Notice the fully adjusted base rate, charges, and cost-to-charge ratio are different for each facility.
Remember that the fully adjusted base rate already includes adjustments for IME, DSH, and wage index.
Once you have completed the calculations, answer the following questions. Submit both your MS-DRGs (60 pts) and the answers to the questions (40 pts).
Which figure has the biggest impact in determining profit/loss for an admission; base rate or cost-to-charge ratio (CCR)? Why?
What is the definition of a CC/MCC? How does the presence of a CC/MCC code impact the reimbursement for an admission
Why do surgical cases tend to have a higher relative weight (RW), and in turn payment, than medical cases?
What can Memorial Hospital do to improve their profit?