Question

Payer Inpatient Services 62% billed charges $6,500 obstetric delivery case rate Outpatient Services 56% of billed charges Fee Schedule $70 per clinic visit $85 per initial OT evaluation $50 per OT visit (non-eval) $75 per clinic visit $45 per OT visit $65 per clinic visit $55 per initial OT evaluation $35 per OT visit (non-eval) $2,100 obstetric delivery per diem $6,350 obstetric delivery case rate

Patient 72341 is admitted as an inpatient for delivery. Length of stay is 3 days. The charges for the encounter are $10,425. The cost of the encounter is $5,848.45. Which payer will reimburse the hospital the highest amount?

Answer 1

As per the data provided in the question, each payer can reimburse the following amount:

Payer A: 62% of charges i.e. $10425= $6463.5

Payer B: $ 6500 (i.e. per case)

Payer C: $2100×3days= $6300

Payer D: $ 6350(i.e. per case)

The cost of the encounter shall be same in case of all payers.So, as per the above calculation, payer B will reimburse the hospital the highest amount.