How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
AYING FOR HOSPITAL AND PHYSICIAN SERVICESAssignment-Two Parts total 4 pagesPart I – Paying for Hospital Services – OverviewMr. 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 assignment questions. Include all formulas and calculations in your paper.DRG Description Case Weight115 Permanent Cardiac Pacemaker 3.5513302 Kidney Transplant 4.1370441 Hand Procedure/Surgery 0.8785Part I – AssignmentAnswer (in about 2 pages) the following questions for Kidney Transplant only:1. What is the operating payment to be paid to the hospital?2. What is the capital payment to be paid to the hospital?3. Will the hospital be eligible for the Medicare outlier payment?4. What is the total payment to the hospital?
Part II – Paying for Physician Services – OverviewMr. Roberts is a 66-year-old Medicare beneficiary. He sought treatments from Dr. Robinson. Assume the following values for the services provided by Dr. Robinson:Categories RVU Geographic Cost Index ProductWork 27.45 1.092 29.98Practice Expense 43.05 1.743 75.04Malpractice 10.32 0.543 5.60Conversion Factor: 64.43Part II – AssignmentPlease answer in about 2 pages the following questions:1. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare participating physician? How much out-of-pocket payment will Mr. Roberts be responsible for?2. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who elects assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?3. How much will Medicare pay Dr. Robinson if Dr. Robinson is a Medicare non-participating physician who does not elect assignment? How much out-of-pocket payment will Mr. Roberts be responsible for?
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