need this asap
Figure 1: HospitalInformation
Bedsize: |
Teachingstatus: |
Wage index:.9971 |
|
300 beds |
Non-teaching |
|
|
Cost to Charge Ratios(CCRs) |
|||
RC250 |
Pharmacy,general |
0.408344 |
|
RC270 |
Supplies,general |
0.796788 |
|
RC271 |
Nonsterilesupply |
0.796788 |
|
RC272 |
Sterilesupply |
0.796788 |
RC276 |
Intraocularlens |
0.796788 |
RC301 |
Chemistry |
0.291546 |
RC312 |
Pathology,surgical |
0.291546 |
RC360 |
Operatingroom |
0.404314 |
RC370 |
Anesthesia |
0.321246 |
RC710 |
Recoveryroom |
0.404314 |
RC730 |
EKG |
0.38251 |
RC920 |
Diagnosticservices |
0.88447 |
Figure 2: Claim Information Hospital OutpatientDepartment
Admitdate |
2/20/2015 |
Dischargedate |
2/20/2015 |
Sex:F |
Age:70 |
LOS: 1day |
|
|
|||
Admitdiagnosis |
366.9 |
Cataract,unspecified |
|
Principaldiagnosis: |
366.10 |
Senile cataract,unspecified |
|
Principalprocedure: |
66984 |
Cataract extraction with IOLinsertion |
|
ChargeDetail |
|||
RevenueCode |
CPT/HCPCSCode |
CodeDescription |
Charge |
250 |
|
|
$475.25 |
270 |
|
|
$380.25 |
271 |
|
|
$1178.18 |
272 |
|
|
$1297.07 |
276 |
|
|
$551.00 |
301 |
36415 |
Routine venipuncture |
$10.00 |
301 |
82565 |
Assay ofcreatinine |
$33.75 |
301 |
84132 |
Assay ofserum potassium |
$33.75 |
301 |
85014 |
Hematocrit |
$34.75 |
312 |
88304 |
Tissue examby pathologist |
$83.50 |
360 |
66984 |
Cataractextraction w/IOL |
$801.33 |
370 |
|
|
$574.00 |
710 |
|
|
$341.00 |
730 |
93005 |
Electrocardiogram, tracing |
$124.50 |
920 |
90772 |
Ther/proph/diaginj, sc/im |
$75.50 |
TOTALCharges |
$5,693.83 |
||
Medicare beneficiary copaymentamount: |
$531.88 |
Figure 3: Claim Information Ambulatory SurgeryCenter
CPT Code:66984 |
Cataract extractionwith IOL |
Charges: $2,500.00 |
Medicare beneficiary copaymentamount: |
$192.76 |
Figure 4: Fee Schedule Information (CY 2012; to get current year seewww.cms.gov)
RevenueCode |
CPT/HCPCS |
FeeSchedule Amt |
StatusIndicator |
301 |
36415 |
$3.00 |
A |
301 |
82565 |
$7.26 |
A |
301 |
84132 |
$6.51 |
A |
301 |
85014 |
$3.35 |
A |
Figure 5: APC Information (CY 2012; to get current year seewww.cms.gov)
RevenueCode |
CPTCode |
APC |
Relative Weight |
StatusIndicator |
312 |
88304 |
0343 |
0.5262 |
X |
360 |
66984 |
0246 |
23.8786 |
T |
730 |
93005 |
0099 |
0.3823 |
S |
920 |
90772 |
0436 |
1.8104 |
S |