High_Cost_Outlier_Exercise - Principle procedure: PTCA...

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High Cost Outlier Exercise The 2011 IPPS high-cost outlier threshold is $23,075; the hospital specific CCR for our facility is .369; the hospital base rate is $5,200.00. Claim amount is $120,601.80. Inpatient claim for John Q. Doe Admit date: 1-1-2010 Discharge date: 1-10-2010 Principal diagnosis: Subendocardial infarction, initial episode of care Secondary diagnosis: Coronary atherosclerosis of native coronary artery Secondary diagnosis: Paroxysmal ventricular tachycardia
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Unformatted text preview: Principle procedure: PTCA Secondary procedure: Insertion of drug-eluting coronary artery stent The MS-DRG for this claim is 557: Percutaneous cardiovascular procedure with drug-eluting stent with major cardiovascular diagnosis. The relative weight for MS-DRG 557 is 2.8717 Based on the claim information given, would this case qualify as a high cost outlier and how much total will the facility receive for this patient?...
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