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IPPS_Outlier - *rate 3.6985 $5,000 = $18 492 Outlier amount...

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IPPS High Cost Outliers 2011 Outlier Threshold: $23,075 Example: Wharton General Hospital: CCR = .329 Base rate = $5,000.00 Total Charges = $131,000.00 MS-DRG Weight for this case = 3.6985 Computing Outlier Status: Cost = actual charge * hospital CCR Cost = $131,000 *.329 = $43,099 MS-DRG payment from Medicare = weight
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Unformatted text preview: *rate 3.6985 * $5,000 = $18, 492 Outlier amount would be $18,492 + $23,075 = $41,567 (the actual costs would have to be greater than this amount to qualify) $43,099-$41,567 = $1532 Medicare will pay 80% of the difference or $1225.6 Hospital will receive $18, 492+$1225.6 or $19,717.6...
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