Posted: March 9th, 2015

Reimbursement Methodology

Reimbursement Methodology

Order Description

1.IPPS: High cost devices are used in many inpatient surgery cases. The Safe-Cross®, radio frequency total occlusion crossing system, is such a device.

The Safe-Cross® guidewire is present on the following claim. Complete an outlier payment calculation to determine whether this claim would qualify for a high cost

outlier payment. If the claim qualifies for outlier payment, calculate the total reimbursement for this claim, including the additional amount that the facility would

receive for the high cost outlier. Formulas are provided for you
2.IPPS: The top 25 MS-DRGs for Hospital A are provided in the table below. Calculate the case mix index for this MS-DRG set

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