Part I – Paying for Hospital Services – Overview

Mr. Scott is a 69-year-old hospitalized for a Permanent Cardiac Pacemaker procedure. Hillcrest Hospital is a large urban hospital in Cleveland that incurred $150,000 in Medicare-approved charges for treating Mr. Scott. Use the information provided in this module as well as the Hospital Payments Example, found in the Course Table of Contents under the Presentation section, to answer the Case 4 assignment questions. Include all formulas and calculations in your paper. Formula sheet is uploaded.

DRG Description Case Weight

115 Permanent Cardiac Pacemaker 3.5513

302 Kidney Transplant 4.1370

441 Hand Procedure/Surgery 0.8785

Part I – Assignment

Answer (in about 3 pages) the following questions for Kidney Transplant only:

What is the operating payment to be paid to the hospital?
What is the capital payment to be paid to the hospital?
Will the hospital be eligible for the Medicare outlier payment?
What is the total payment to the hospital?

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