Applied Sciences

HOPPS/ASC: Use the information found in figures 1–5 below to completethe OPPS payment calculations in table 1 and the ASC PPS payment calculationsin table 2. Determine the OPPS and ASC reimbursement rates for acataract procedure. Answer the discussionquestion.

Click and download the exercise and the answer sheet. Submit answer sheet via blacboard by or before 11/9/2015

Figure 1: HospitalInformation
Bedsize:

Teachingstatus:

Wage index:.9971

300 beds

Non-teaching

Cost to Charge Ratios(CCRs)

RC250

Pharmacy,general

0.408344

RC270

Supplies,general

0.796788

RC271

Nonsterilesupply

0.796788

RC272

Sterilesupply

0.796788

RC276

Intraocularlens

0.796788

RC301

Chemistry

0.291546

RC312

Pathology,surgical

0.291546

RC360

Operatingroom

0.404314

RC370

Anesthesia

0.321246

RC710

Recoveryroom

0.404314

RC730

EKG

0.38251

RC920

Diagnosticservices

0.88447

Figure 2: Claim Information Hospital OutpatientDepartment

Admitdate

2/20/2015

Dischargedate

2/20/2015

Sex:F

Age:70

LOS: 1day

Admitdiagnosis

366.9

Cataract,unspecified

Principaldiagnosis:

366.10

Senile cataract,unspecified

Principalprocedure:

66984

Cataract extraction with IOLinsertion

ChargeDetail

RevenueCode

CPT/HCPCSCode

CodeDescription

Charge

250

$475.25

270

$380.25

271

$1178.18

272

$1297.07

276

$551.00

301

36415

Routine venipuncture

$10.00

301

82565

Assay ofcreatinine

$33.75

301

84132

Assay ofserum potassium

$33.75

301

85014

Hematocrit

$34.75

312

88304

Tissue examby pathologist

$83.50

360

66984

Cataractextraction w/IOL

$801.33

370

$574.00

710

$341.00

730

93005

Electrocardiogram, tracing

$124.50

920

90772

Ther/proph/diaginj, sc/im

$75.50

TOTALCharges

$5,693.83

Medicare beneficiary copaymentamount:

$531.88

Figure 3: Claim Information Ambulatory SurgeryCenter

CPT Code:66984

Cataract extractionwith IOL

Charges: $2,500.00

Medicare beneficiary copaymentamount:

$192.76

Figure 4: Fee Schedule Information (CY 2012; to get current year seewww.cms.gov)

RevenueCode

CPT/HCPCS

FeeSchedule Amt

StatusIndicator

301

36415

$3.00

A

301

82565

$7.26

A

301

84132

$6.51

A

301

85014

$3.35

A

Figure 5: APC Information (CY 2012; to get current year seewww.cms.gov)

RevenueCode

CPTCode

APC

Relative Weight

StatusIndicator

312

88304

0343

0.5262

X

360

66984

0246

23.8786

T

730

93005

0099

0.3823

S

920

90772

0436

1.8104

S

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