Kidney Transplant Case Assignment Expectations

Kidney Transplant Case Assignment Expectations

Question one
The formula to calculate operating payment is as shown below:
Operating Payment = DRG Relative Weight x ((Labor Related Large Urban Standardized
Amount x Core-Based Statistical Area (CBSA) wage index) + (Nonlabor Related National Large
Urban Standardized Amount x Cost of Living Adjustment)) x (1+ Indirect Medical Education +
Disproportionate Share Hospital)
= 4.1370 x (($3,135.49 x 1.5904) + ($1,274.49 x 1)) x (1 + 0.316935 + 0.129484)
= 4.1370 x ($4986.6833 + $1,274.49) x 1.446419
= $37,465.83
Question two
The formula to calculate capital payment is as shown below:

Capital Payment = DRG relative Rate x Federal Capital Rate x Large Urban Add-On x
Geographic Cost Adjustment Factor x Cost of Living Adjustment) x (1+ Indirect Medical
Education + Disproportionate Share Hospital)

= (1.395532 x 320.6464 x 1.627565 x 0.997278 x 1) x (1 + 0.330054 + 0.166027)
= 726.307869 x 1.496081
= $1086.62

Question three
The hospital will not be eligible for the Medicare outlier payment mainly because the patient will
not be required to stay at the hospital for prolonged period of time and the overall cost incurred
in treating the patient does not surpass what is paid by the Medicare.
Question four
The total payment will be obtained by cumulating operating payment and capital payment as
shown below:
Total cost = operating payment + capital payment
= $37,465.83 + $1086.62
= $38552.45


Centers for Medicare and Medicaid, (2009). Acute Care Hospital Inpatient Prospective Payment
System: The Medicare Learning Network Payment Systems Fact Sheet Series.

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